New Parent Intake Form

* = required

About You

First Name*

Last Name*

Mailing Address*

Street Address City State / Province / Region ZIP / Postal Code

Email Address*

Phone Number*

I am:

a new parent
the spouse, significant other, or family member of a new parent
adoptive parent
foster parent

About Your Baby

Baby's name*

Baby's sex*

Baby's date of birth*

State where the baby was born:

Massachusetts
Other

If "other", please list the state where the baby was born:

Optional Additional Information

Please share the following information to help us make the most meaningful connection when possible:

Date of birth of new mom/parent:

Ethnicity of parent(s):

Primary language of parent(s):

We may be able to connect you with a bilingual First Call parent.

Any health/medical information about mom or baby that may be helpful for us in offering the most meaningful support and resources?

Any information about your background or family structure (including ages of any other children) that may be helpful for us in offering the most meaningful support and resources?

We are here for you!

We offer a connection to a First Call parent mentor, who is the parent of a younger child with Down syndrome. This parent offers a safe, confidential space to connect, share, and feel supported.

Would you like to be contacted by a First Call parent mentor?*

yes
not at this time

Would you prefer to be contacted initially by:

email
text
WhatsApp

We would love to share our New Family Welcome Package with you that includes resources, information, and gifts for your baby. Would you like to receive this package?

yes
not at this time

We would love to share our New Family Welcome Package with you that includes resources, information, and gifts for your baby. Would you like to receive this package?

yes
not at this time

Any additional information that you would like to share to best help us support you and your family:

Lastly, we are curious how you heard of the MDSC First Call Program?

online search
social media
medical provider
other

Please share the provider’s name and/or group affiliation:

If other, please share:

Consent Form

Consent*

I have reviewed the waiver and consent

Please review this waiver/consent.

NEW PARENT MUST CHECK BOX OR SIGN FORM
I understand that I will be speaking with a trained parent volunteer and that this conversation does not represent medical advice or professional counseling. The Parents First Call Program does not provide advice in any way. My conversation(s) with a parent mentor will be confidential, and only a brief synopsis of our call(s) will be shared with the program's Family Support Team to ensure individualized resources and supports are provided to me. My personal information will not be shared and will be kept confidential within the Parents First Call Program.

If you have not heard from a First Call parent in 24 hours, you may email us at firstcall@mdsc.org

New Parent Intake Form