Adult Adoption Intake Questionnaire
Please complete this client-facing intake form so we can create your client record and Adult Adoption matter in VFL Toolkit and populate the required template fields. Some questions will appear only if they apply to your situation.
As a family law practice, we always prefer to put a face with a name. If you would like, share the photo of yourself that you like most. It can be of just you, or of you with your family. This is completely optional.
Share a photo of yourself (optional)
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One photo, JPG or PNG. A clear, upright photo of your face works best.
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Photo caption (optional)
For example: Me with Sam and Riley, summer 2026.
Adopting petitioner and contact
Adopting petitioner first name
*
Adopting petitioner middle name
Adopting petitioner last name
*
Adopting petitioner suffix
Adopting petitioner date of birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
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Day
Please select a year
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0111
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Year
Adopting petitioner state of birth
If born in the United States. Needed for the Virginia Report of Adoption (VS-21).
Adopting petitioner country of birth
If born outside the United States.
Adopting petitioner birth or maiden last name
Adopting petitioner race or ethnicity
Please Select
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Two or More Races
Other
As it should appear on the Virginia Report of Adoption (VS-21).
Adopting petitioner other race or ethnicity
If you chose Other.
Adopting petitioner pronouns
*
She/her
He/him
They/them
Custom
Adopting petitioner custom pronouns
Adopting petitioner sex on birth record
Male
Female
Adopting petitioner street address
*
Adopting petitioner city
*
Adopting petitioner state
*
Adopting petitioner ZIP code
*
Adopting petitioner street address when the adoptee was born
Where you lived when the adoptee was born, if applicable. Leave blank if it does not apply. Needed for the Virginia Report of Adoption (VS-21).
Adopting petitioner city when the adoptee was born
Adopting petitioner state when the adoptee was born
Adopting petitioner ZIP when the adoptee was born
Adopting petitioner phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Adopting petitioner email address
*
example@example.com
Is the adopting petitioner married?
*
Yes
No
Adopting petitioner's relationship to the adult adoptee
*
Please Select
Mother's parent
Father's parent
Great-grandparent on mother's side
Great-grandparent on father's side
Mother's sister
Father's sister
Mother's brother
Father's brother
Adult nephew
Adult niece
Adult brother
Adult sister
Stepmother
Stepfather
Adult stepbrother
Adult stepsister
Unrelated by blood marriage or adoption
Other adult relative by marriage or adoption
Relationship description
Date adopting petitioner and adoptee began living in the same household
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Type the date as MM-DD-YYYY, for example 03-09-1988, or pick it from the calendar.
Date adopting petitioner first met the adoptee
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Type the date as MM-DD-YYYY, for example 03-09-1988, or pick it from the calendar.
Will the adopting petitioner's spouse join this adoption as a second petitioner?
*
Yes
No
Spouse joining as second petitioner
Spouse first name
Spouse middle name
Spouse state of birth
If born in the United States.
Spouse country of birth
If born outside the United States.
Spouse last name
Spouse race or ethnicity
Please Select
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Two or More Races
Other
As it should appear on the Virginia Report of Adoption (VS-21).
Spouse other race or ethnicity
If you chose Other.
Spouse sex on birth record
Male
Female
Spouse suffix
Spouse date of birth
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
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Day
Please select a year
0
01
011
0111
01111
Year
Spouse pronouns
She/her
He/him
They/them
Custom
Spouse custom pronouns
Spouse role to adoptee
Birth mother
Birth father
Adoptive mother
Adoptive father
Does the spouse use the same address as the adopting petitioner?
Yes
No
Spouse street address
Spouse city
Spouse state
Spouse ZIP code
Marriage date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Type the date as MM-DD-YYYY, for example 03-09-1988, or pick it from the calendar.
Marriage place
Adult adoptee
Adult adoptee current first name
*
Adult adoptee current middle name
*
Adult adoptee current last name
*
Adult adoptee current suffix
Adult adoptee date of birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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Day
Please select a year
0
01
011
0111
01111
Year
Adult adoptee city of birth
*
Adult adoptee state of birth
*
Adult adoptee country of birth
*
Adult adoptee sex on birth record
Male
Female
Adult adoptee birth certificate number
*
Adult adoptee pronouns
*
She/her
He/him
They/them
Custom
Adult adoptee custom pronouns
Has the adult adoptee ever used a different legal name?
Yes
No
Adult adoptee prior legal name at birth or earliest prior name
Will the adult adoptee's legal name change after adoption?
Yes
No
Adult adoptee new first name
Adult adoptee new middle name
Adult adoptee new last name
Adult adoptee new suffix
Adult adoptee birth parent 1
Birth parent 1 first name
*
Birth parent 1 middle name
Birth parent 1 last name
*
Birth parent 1 suffix
Birth parent 1 relationship
*
Please Select
Birth mother
Birth father
Adoptive mother
Adoptive father
Birth parent 1 date of birth
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
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10
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12
13
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Day
Please select a year
0
01
011
0111
01111
Year
Birth parent 1 state of birth
Birth parent 1 country of birth
Birth parent 1 pronouns
She/her
He/him
They/them
Custom
Birth parent 1 custom pronouns
Is birth parent 1 deceased?
Yes
No
Birth parent 1 street address
Birth parent 1 city
Birth parent 1 state
Birth parent 1 ZIP code
Adult adoptee birth parent 2
Birth parent 2 first name
*
Birth parent 2 middle name
Birth parent 2 last name
*
Birth parent 2 suffix
Birth parent 2 relationship
*
Please Select
Birth mother
Birth father
Adoptive mother
Adoptive father
Birth parent 2 date of birth
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
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20
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28
29
30
31
Day
Please select a year
0
01
011
0111
01111
Year
Birth parent 2 state of birth
Birth parent 2 country of birth
Birth parent 2 pronouns
She/her
He/him
They/them
Custom
Birth parent 2 custom pronouns
Is birth parent 2 deceased?
Yes
No
Statutory basis
Adult adoption statutory scenario
*
Stepchild over age 18
Close relative over age 18
Birth child or lived in petitioner's home for at least 3 months and over age 18
Good cause shown
Good-cause reasons
*
Formalizing a longstanding parent-child relationship
Providing legal permanence
Aligning legal status with family reality
Estate planning
Recognizing stepparent or kinship caregiving
Medical caregiving or next-of-kin status
Educational benefits
Other
Other good-cause description
Birth parent 2 street address
Birth parent 2 city
Birth parent 2 state
Documents to share with our office
If you have documents you would like us to see (for example court orders, birth certificates, marriage certificates, name-change orders, or photographs), upload them here. You may add more than one file. Uploading is optional; your files are delivered securely to our office together with your answers.
Would you like to upload a file or files?
*
Yes
No
Upload documents to share with us
Upload a File
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Birth parent 2 ZIP code
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