Medical Resources

*  Name
*  Email Address
*  Work Phone:
*  Mobile Phone:
*  Home Phone:

What method of contact do you prefer?




*  Where are you in the adoption process?

I have just started my application
I have received the file of a Waiting Child to review.
I have received a referral.
I am currently working to adopt through:

Please choose the medical screening service level:

  Service Level: Fee:

Preferred

$300.00

Prestige

$350.00

Would you like to donate to the ICAN fund? Money donated to the ICAN fund goes directly to our projects that improve orphanage conditions for children around the world. Projects include the donation of libraries, learning centers, and physical therapy equipment along with assistance and training in the evaluation and care of children with special needs.


$  
Example: 150.00
Amount
   
Payment Authorization
We accept Visa or MasterCard Only.
*  Credit Card #:
*  First Name as it appears on Credit Card:
*  Last Name as it appears on Credit Card:
Expiration Date: /
*  3-digit Security Number (CVV):  
*  Billing Address:
*  City:
*  State:
*  Zip:
*  Driver's License #
*  DL State Issued:
 
  





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