Request a Birthparent Information Packet

If you are pregnant and are thinking about adoption, you can use the form below if you would like to request an information packet and/or have a birthparent counselor contact you. All information will be kept strictly confidential and you can provide as much or as little information about yourself as you would like.

For submitting your data don't fill this following email field:

Name:
Address Line 1:
Address Line 2:
City:
State:
Zip:
I’d also like a birthparent counselor to contact me:	Yes No
If Yes:
Telephone Number:
Is it ok to leave a voicemail message?	Yes No
-OR-
Email Address:
Comments

The Children's Home of Pittsburgh & Lemieux Family Center • 5324 Penn Avenue Pittsburgh, PA 15224 • Phone: 412-441-4884 • Fax: 412-441-0167