Arkansas Birth Parent Contact Preference Form (Form A) (VR-501)
Official state formAdoptionForm VR-501Free downloadLast verified November 10, 2026
A birth parent of an adopted person uses this form to say whether he or she wants direct contact, contact through an intermediary, or no contact from a person who requests the adoption file. It is filed with the State Registrar at Arkansas Department of Health Vital Records.
Who can use this form
- A birth parent of an adopted person completes the form. Each birth parent completes his or her own.
- The office holds adoption files only for persons born in Arkansas.
- The preference is advisory. The form says no law requires the adoptee to follow it.
- The birth parent may change the preference at any time by filing a revised form.
What to send with it
- The signed and notarized form.
- A Family History Information Form (Form B), unless one was submitted before.
- A copy of the birth parent's identification, as listed in the Birth Parent Information Instructions. Send copies, not originals.
Where to send it
- Mail to
- Arkansas Department of Health Vital Records Department State Registrar 4815 West Markham Street, Slot 44 Little Rock, AR 72205
- State fee
- Not provided
- Typical processing
- Not provided
- Form revision
- May 2018
- Source
- Official government page