Birth Parent Counseling Contract Service Birth Parent Counseling Contract ServiceYour counselor will assist you in completing your paperwork, coordinating your contact with the adoptive family prior to and after delivery, and guiding you through the placement process. They can also provide brief therapy and support as desired. State regulations require that we have at least two face-to-face counseling sessions with you prior to relinquishment, unless you refuse such counseling. Please indicate the support you would like from your counselor: Counseling concerning alternatives for keeping and raising my child noyes Counseling concerning the placement decision noyes Mediation between me and the birth father noyes Counseling with my family to gain their support noyes Parenting Skills noyes Money-Management noyes Referral for Medication noyes Birth Control Information noyes Counseling for abuse/trauma issues noyes No counseling noyes Other Your counselor plans to meet with you, in person or by phone. Please consider what help you may need before the placement as well as after, and indicate what use of this time will be most helpful to you.Before placement, I would like to meet with my counselor: Once a week noyes Every two weeks noyes Only if i call noyes Just to complete paperwork and line up family noyesYour counselor will work out meeting times and places with you in your first meeting. If, at any time, you need to speak to your counselor, she/he can be reached by calling the birth parent line at (800) 835-6360. They will have your counselor call you as soon as possible.By signing these documents electronically, I acknowledge that the electronic mark or symbol used to sign is representative of, functionally equivalent to, and shall be treated exactly the same as my handwritten signature. By making such a mark, I affirm that I do so with the intent to sign the forms or records so marked. I understand that by signing these documents electronically I will be bound by the terms of the documents, the same as if I had signed with my handwritten signature. Birth Parent Signature Date A Act of Love ·9561 South 700 East, Suite 101, Sandy, Utah 84070·(801) 572-1696·Fax (801) 572-9303 24-Hour Birth Parent Line 1-800-835-6360 ©Copyright A Act of Love 2010 Please leave this field empty.