David M. McCormick & Associates

		Adoption Analysis

		Name		*
		D.O.B.
		Social security number
		Spouse's name
		Spouse's D.O.B.
		Spouse's social security number
		Address		*
		City		*
		State		*
		Zip		*
		Home phone		*
		Cell phone		*
		E-Mail address		*
		Can we contact you via e-mail?		yes no
		What is your preferred form of communication
		Have you contacted another attorney concerning this matter?		yes no
		If yes, what is the attorney's name
		If yes, did you retain this attorney?		yes no
		Have you contacted or are currently involved with an adoption agency?		yes no
		If yes, which agency
		Has a homestudy been completed?		yes no
		What type of adoption are you seeking legal assistance
		Child's name
		Child's D.O.B.
		Birth mother's name
		Birth father's name
		Child's current city
		Child's current state
		Child's current address

		What are the circumstance surrounding the placement and/or reason for seeking adoption


		Please provide any additional information that may be useful

		List any questions you have for us
		Enter number shown on image