Adoption Advisement

North Texas Family Services

Lauren Gordon, LCSW

8301 Lakeview Parkway Suite 111-131

Rowlett, TX 75088

214.675.3978

laurengordon@ntxfamilyservices.com

www.ntxfamilyservices.com
Please check each box and sign at the bottom.

I recognize this social study will involve collecting a social history for all adults in the household, conducting interviews with verbal children, and touring the home environment. I also acknowledge that some questions may feel quite personal, but they are necessary to obtain more detailed information. Not providing this information could lead to delays in completing my social study, necessitate additional home visits, or even result in the denial of the study.
Contacting the Evaluator:
Services Not Provided:
Professional Practice Statements
Insurance Coverage
Release of Information:
I have been provided a copy of this contract and invoice and fully agree to the terms listed.
Parent 1 Printed Name
Date

MonthDayYear
Date
Signature
Parent 2 Printed Name
Date

MonthDayYear
Date
Signature
Should be Empty: