Antepartum Support and Postpartum Depression Support

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New Mom's, Contact Us

The more we know about your situation, the more we can help you.
Please fill in as much information as possible.  All fields are optional.

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  (e.g. Mr., Mrs., Dr., etc.)

First Name Last Name Mailing Address City State / Province Zip / Postal Code Country Phone Number Email Address Age Ages of Children Baby's Name Marriage Status Spouse's / Partner's Name Would you say that your marriage / partnership is supportive? Your Employment Status How did you learn about us? Are you currently suffering from a postpartum disorder? If yes, please describe your symptoms. Are you currently receiving professional help? Are you currently on any medication for PPD / APD? Who is your doctor? Would you like an information packet sent to your email? Not yet available. Would you like an information packet sent to your mailing address? Would you like a phone support volunteer to call you? If yes, when is a good time to call you?

Would you like to attend a support group?

If yes, which group would you like to attend?

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(Please tell us your story.)

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Baby Blues Connection, PO Box 1122, Portland, OR  97207-1122, 866-616-3752