Barker Foundation - Confidential Pregnancy Services Information Request Form

HEADQUARTERS

The Barker Foundation
7979 Old Georgetown Road
First Floor
Bethesda, MD 20814
301-664-9664

PREGNANCY HOTLINE
1-800-821-3104

__________

SATELLITE OFFICES

2957 Monticello Drive
Falls Church, VA 22042
703-536-1827

1066 - 30th Street, NW

Washington, DC 20007
202-298-7724

Confidential Prospective Birth Parent Services Information Request

Call our free Pregnancy Services Hotline
1-800-821-3104
24 hours a day, 365 days a year

All information requested is optional except we do ask for
either a telephone number or email address so a counselor can get in touch with you.

Date:
Name
Street Address:
City
State
Zip
Telephone (home): (required if no email address is provided)	with area code, please	To ensure your privacy, do you want us to block out the Barker Foundation phone number from your Caller ID? YES no
Best Time to Reach You:	o'clock	am pm
Your email address (required if no phone number is provided)

Do you want to speak with a Barker pregnancy counselor? (It's free, private, and confidential.)	Yes no
If you have any beginning questions or concerns you'd like answered privately, please share them here.

The Barker Foundation doesn't sell, rent, exchange or disclose prospective birthparent or adoptive parent information with any third parties.
To protect your privacy, any information we send by regular mail will be sent in a confidential envelope.