| Today's date:
|
| Time of call:
|
| Name of caller:
|
| Phone number &
extension of caller:
|
| Baby's full Chinese name:
|
| Translation of baby's name:
|
| Full name of baby's
orphanage:
|
| City:
|
| Province:
|
| How old is the baby?:
|
| Date of birth:
|
| Measurements & when
taken:
|
| Medical information:
|
| Who will translate the
referral? The medical report?
|
| When should I accept the
referral? (important if I want to have another Dr.
review the information)
|
| Information regarding
abandonment (note left, etc.):
|
| Foster Care? How long?
With whom?:
|
| Travel group number:
|
| Other families in our
group referred from same orphanage?:
|
| Have you had referrals
from this province before? From this orphanage?
|
| What items can this
orphanage use the most?
|
| Names of others in our
travel group:
|
| May I have the other group
members' email or phone numbers and names?
|
| How can we get a package
to baby's orphanage?:
|
| Who will translate the
note we enclose?:
|
| Can our facilitator
contact the orphanage for current information?
|
| If feasible, can he take
current photos or get current medical
information?
|
| What is the next thing I
need to do?
|
| When will the next payment
be needed, travel arrangements, or the money
wired to the agency and/or to China?
|
| Please e-mail us baby's
photo to e-mail address
|
| Please fax information to
this number:
|
| Please FEDEX us the
referral info to this address
|
| What is the tracking
number for the package?
|
