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.

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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