Adoption Counseling Questionnaire Today's Date MM DD YYYY Full Name Email Address Phone (###) ### #### What brings you to adoption counseling? Is there something specific, such as a particular event? Be as detailed as you can. What are your goals for counseling? Have you or your family seen an adoption counselor before? Yes No If yes, what year did you start, for how long did you attend, and what was the outcome? Are you an adoptive parent/adoptee/birth parent/or a family member? Adoptive Parent Adoptee Birth Parent Family Member What days and times work best for you to receive counseling services? Is there anything else you would like us to know? Thank you!
