Second-Parent Adoption Intake Questionnaire

Adopting second parent and contact
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 child or children. This is completely optional.
Share a photo of yourself (optional)

One photo, JPG or PNG. A clear, upright photo of your face works best.
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Photo caption (optional)
Adopting parent first name

First NameLast Name
Adopting parent middle name
Adopting parent last name
Adopting parent suffix
Adopting parent date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearType the date as MM-DD-YYYY, for example 03-09-1988, or pick it from the calendar.
Adopting parent state of birth
If born in the United States. Needed for the Virginia Report of Adoption (VS-21).
Adopting parent country of birth
If born outside the United States.
Adopting parent birth or maiden last name
Adopting parent race or ethnicity
As it should appear on the Virginia Report of Adoption (VS-21).
Adopting parent other race or ethnicity
If you chose Other.
Adopting parent pronouns
Adopting parent sex on birth record
Adopting parent custom pronouns
Adopting parent role
Adopting parent phone number
Please enter a valid phone number.Format: (000) 000-0000.
Adopting parent street address when child was born
Where you lived when the child was born. Leave blank if it does not apply. Needed for the Virginia Report of Adoption (VS-21).
Adopting parent city when child was born
Adopting parent state when child was born
Adopting parent ZIP when child was born
Adopting parent email address
example@example.com
Adopting parent street address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Adopting parent city
Adopting parent state
Current legal parent state of birth
If born in the United States.
Current legal parent country of birth
If born outside the United States.
Adopting parent ZIP code
Current legal parent race or ethnicity
As it should appear on the Virginia Report of Adoption (VS-21).
Current legal parent other race or ethnicity
If you chose Other.
Date adopting parent began living in the same household as the child

MonthDayYear
2 digit month, 2 digit day, 4 digit yearType the date as MM-DD-YYYY, for example 03-09-1988, or pick it from the calendar.
Current legal parent sex on birth record
Date adopting parent first met the child

MonthDayYear
2 digit month, 2 digit day, 4 digit yearType the date as MM-DD-YYYY, for example 03-09-1988, or pick it from the calendar.
Child's current legal parent
Current legal parent first name

First NameLast Name
Current legal parent middle name
Current legal parent last name
Current legal parent suffix
Current legal parent date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearType the date as MM-DD-YYYY, for example 03-09-1988, or pick it from the calendar.
Current legal parent birth or maiden last name
Current legal parent pronouns
Current legal parent custom pronouns
Current legal parent role
Does the current legal parent use the same address as the adopting parent?
Current legal parent street address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Adoptee sex on birth record
Current legal parent city
Current legal parent state
Current legal parent ZIP code
Child to be adopted
Adoptee current first name

First NameLast Name
Adoptee current middle name
Adoptee current last name
Adoptee current suffix
Adoptee date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearType the date as MM-DD-YYYY, for example 03-09-1988, or pick it from the calendar.
Adoptee state of birth
Adoptee country of birth
Adoptee birth certificate number
Adoptee pronouns
Adoptee custom pronouns
Has the adoptee ever used a different legal name?
Adoptee prior legal name at birth or earliest prior name
Will the adoptee's legal name change after adoption?
Adoptee new first name
Adoptee new middle name
Adoptee new last name
Adoptee new suffix
Conception and donor
Donor type
Known donor first name

First NameLast Name
Known donor middle name
Known donor last name
Known donor suffix
Known donor date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearType the date as MM-DD-YYYY, for example 03-09-1988, or pick it from the calendar.
Known donor state of birth
Known donor country of birth
Known donor pronouns
Known donor custom pronouns
Known donor relationship to child
Known donor relationship to petitioners
Donor number if any
Date of donor agreement

MonthDayYear
2 digit month, 2 digit day, 4 digit yearType the date as MM-DD-YYYY, for example 03-09-1988, or pick it from the calendar.
Cryobank name
Other cryobank name
Cryobank donor number
Marriage
Parents' marriage date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearType the date as MM-DD-YYYY, for example 03-09-1988, or pick it from the calendar.
Marriage city
Marriage 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, donor agreements, 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?
Upload documents to share with us

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Should be Empty:

Adopting second parent and contact

Child's current legal parent

Child to be adopted

Conception and donor

Marriage

Documents to share with our office