Print this, fill it out & take it to China with you.

At a glance....

Adoption Agency :                                                                                          

Emergency or pager #:                                                                                    

In-China Facilitator Contact info:                                                                                            

Pediatrician:                                                                                                  

Phone #:                                                                                                       

International Adoption Medical Specialist:                                                            

Phone#:                                                                                                         

Family Practitioner:                                                                                          

Phone #:                                                                                                       

Hotel/Address:                                                                                                                      

Phone # / Confirmation #:                                                                                                    

Hotel/Address:                                                                                                                      

Phone # / Confirmation #:                                                                                                    

Travel Agency Contact / Phone #:                                                                                        

American Consulate in Guangzhou: 

Phone: 011-86-20-8188-8911  ext. 201 or 204               Fax: 011-20-8188-3000  

Email: [email protected]    (remove the international calling codes in China)

Family or contacts at home in case of emergency:

Name:                                                                                                           

Phone #:                                                                                                         

Health Insurance Company:                                                                                 

Group Name & #:                                                                                              

Phone #:                                                                                                          

Passport #:                                                                                                       

Passport #:                                                                                                       

Credit cards:

CC Company/#/phone #:                                                                                   

CC Company/#/phone #:                                                                                   

CC Company/#/phone #:                                                                                   

Calling Card details:                                                                                                                   

Additional: