Adoption Questionnaire

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Hello and welcome to the Adoption Questionnaire. This is not a portable questionnaire and has to be completed in one session; it cannot be saved or transferred to another computer. If you prefer to use the portable questionnaire please download the Adobe Portable Questionnaire which can be saved and transferred to any computer.

The fields that are required to be completed on the questionnaire are marked with a red astir ( * ). If any of those fields are missing or not complete the Questionnaire cannot be submitted.

Complete Privacy is guaranteed. We have shortened all personal identifying information to just the Last 4 Digits. So we do not collect the super sensitive information. That is good for everyone involved.

When you are finished, click the submit button at the bottom of the page.

Do not hesitate to reach our customer service if you require assistance.

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Main Customer Contact Information:


The US State and County you will be filing your adoption papers in. Also, you must qualify for residency there.

  1. 1. A Child Adoption is a normal adoption where the child is KNOWN to the adopting family. But, the families are not related.
  2. 2. A Step Parent Adoption is an adoption of your SPOUSE’S child(ren) AFTER you have been married.
  3. 3. An  Adult Adoption is an adoption of a person over 18. The adopted person is an adult.
  4. 4. A Relative Adoption is an adoption of a minor (under 18) by a family member that is related.

Online Adoption Questionnaire

This Questionnaire is for office use only. Please answer the questions as best as you can. We will email/call you if we need more information than this. Complete confidentiality is assured. If you need more room to write, use the comments portion, at the bottom of each section. If you have any questions throughout this Questionnaire, donít be shy. Go to our website's Customer Area and contact us. We are here to help you through this process in a smooth and orderly manner. That is our Goal.

There are 3 sections to this Questionnaire:

Section 1 is ONLY for the Natural/Custodial Parent(s)

Section 2 is ONLY for the Adoptive Parent(s).

Section 3 is ONLY for the Adoptee(s)

SECTION 1

Natural or Custodial Parent(s) Information

Click in the Box if this is an Adult adoption to Skip this Section

Natural Mother

Is the Mother Missing? (check if yes)

1.
2.
3.
(if same)
City: State:

Natural Father

Is the Father Missing? (check if yes)

1.
2.
3.
(if same)
City: State:
Has the Mother and Father ever been married to each other previously? IF Yes, please provide: (see below))
If never married to other custodial parent, did you ever cohabitate? IF Yes, what dates did you live together? (Approximately)
From: To:
Has any court ever terminated your parental rights to the adoptee IF Yes, please provide:
1. which court: 2. case number: 3. dates of case:
Has any court ever terminated your parental rights to the adoptee IF Yes, please provide:
1. which court: 2. case number: 3. dates of case:
Have you ever previously adopted a child/adult? If Yes please give: (see below):
Names:
1.
Date:
1.
2.
2.
3.
3.
Have you ever previously adopted a child/adult? If Yes please give: (see below):
Names:
1.
Date:
1.
2.
2.
3.
3.

SECTION 2

This section is for the Parent(s) wishing to Adopt

Special Note:This section is required to be filled out for all types of adoption
Please choose Mother or Father or Both

Mother or Father

Adoptive Mother


1.
2.
3.
(if same)
City: State:
Is/are the Adopting Parent(s) Related to the Person being Adopted? (if so, how?):

Adoptive Father


1.
2.
3.
(if same)
City: State:
Is/are the Adopting Parent(s) Related to the Person being Adopted? (if so, how?):
Were you ever married previously? IF Yes, please provide: (see below)
Were you ever married previously? IF Yes, please provide: (see below)
How long have you known the adoptee? *
What date did you begin living with the adoptee? *
What is the total length of time you have lived with the adoptee?
How long have you known the adoptee? *
What date did you begin living with the adoptee? *
What is the total length of time you have lived with the adoptee?
Have you ever previously adopted someone?
If Yes please give: (see below)
Names:
1.
Date:
1.
2.
2.
3.
3.
Have you ever previously adopted someone?
If Yes please give: (see below)
Names:
1.
Date:
1.
2.
2.
3.
3.

SECTION 3

ADOPTEE(S) INFORMATION

Select how may adoption you need?

Adoptee # 1


1. 2.

Adoptee # 2


1. 2.

Adoptee # 3


1. 2.

Adoptee # 4


1. 2.


 

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