Iowa Biological Parent Medical History Form
Official state formAdoptionFree downloadLast verified November 10, 2026
Form a birth parent may file with the Bureau of Health Statistics to leave family medical history. The history is released with the noncertified copy of the original birth certificate when an adult adoptee requests it.
Who can use this form
- A birth parent of an adoptee
- The child's birth must have occurred in Iowa
What to send with it
- The completed and signed eight-page form
- File it by mail or in person at the Bureau of Health Statistics only
Where to send it
- Mail to
- Iowa Department of Public Health Bureau of Health Statistics 321 E. 12th St, Lucas State Office Building Des Moines IA 50319
- State fee
- Not provided
- Typical processing
- Not provided
- Form revision
- Created 05/2021
- Source
- Official government page