Client Questionnaire - Printable

A MESSAGE FROM MARY

Dear Mother-to-be,

If you are a college or working woman in need of the Nurturing Network's specialized services, please feel free to print our Client Application and return it to us at your earliest convenience.  It is my hope that our Network will be able to provide both encouragement and practical resources during this special, yet vulnerable, time in your life. You can rest assured that your message will be received and held in confidence. If you prefer, you may fill out our Client Questionnaire online.

You may complete the Questionnaire either before or after contacting us by phone at our toll free number: 1-800-TNN-4MOM.  Please be sure to let us know the most convenient time to respond to your request by phone.

If you do not have Adobe Acrobat Reader that will allow you to print and view our Questionnaire, this free program can be downloaded from http://www.adobe.com.  Macintosh users will need to save the Questionnaire to their desktop and open it with Adobe Acrobat Reader before they can print it. 

As a helpful hint, you may wish to have information about your education, employment and medical history readily available along with your most current contact information before you actually complete our Questionnaire. The more complete you can be in sharing this personal information with us, the greater opportunity we have to effectively meet your unique and comprehensive needs.
As soon as we receive your completed Questionnaire, we will be able to begin the process of trying to assist you. Please mail your Questionnaire to me at P.O. Box 1489 White Salmon, WA  98672. If you have any questions as you complete this form, please feel free to call us at our 800#. You are also welcome to send an Email note or place a phone call letting us know that your Questionnaire is in the mail.

I also encourage you to print our Helpful Hints for Clients, which are intended for a woman facing an unplanned pregnancy. Other pages of this website, particularly Need Help? may be of special interest to you. We have tried to anticipate and answer your questions while offering the assurance that there exists strong, practical support for the birth alternative. The support we offer will take into account your future as well as that of your child.

Always,



Mary Cunningham Agee
President and Founder