Drug and Alcohol Consent and Questionnaire of Birth Mother Form

Drug and Alcohol Consent and Questionnaire of Birth Mother

Note to Birth Mother: This questionnaire is designed to aid health care professionals, our Agency, and the Prospective Adoptive Parent(s) make decisions regarding your child and his or her health. It is very important that you answer all questions completely and truthfully as your adoption plan could be disrupted if your child is born with drug or alcohol related problems which were not disclosed before you chose the Adoptive Parent(s).