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Adoption Medicine Clinic
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Adoption Medicine Clinic
Department of Pediatrics
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FAQs
Welcome to Adoption Medicine Clinic Services System
Create Account Here
Parent 1
(Primary Contact)
First Name:
*
Last Name:
*
Address 1:
*
Address 2:
City/State/Zip:
*
Country:
*
Day Phone:
*
Eve/Wknd Phone:
*
Email:
*
Parent 2
(We will attempt to reach Parent 2 if we are unable to reach Parent 1)
First Name:
Last Name:
Day Phone:
Eve/Wknd Phone:
Email:
Pref Contact Method:
Email
Phone
Username:
*
Password:
*
Re-Type Password:
*
Security Question:
*
Security Answer:
*
Name of Agency:
How you heard about us:
Medical professional (Who? What clinic/institution?)
Adoption Agency (Agency name?)
Chat Room (Which one?)
Search Engine (Yahoo, Google, Other?)
Friend or Family (Optional: name?)
I/we heard one of your staff give a presentation (Which staff/conference?)
Used your services previously
Print AD (Which publication?)
Other (Please list)
Explain:
The Adoption Medicine Clinic will never sell your contact information with any outside party. However, we may share your contact information with Minnesota Medical Foundation, the philanthropic arm of our efforts to advance research, education and care for international adoptees and orphaned children worldwide. Please uncheck this box if you do NOT wish to receive annual updates from Minnesota Medical Foundation