Virginia Birth Parent Contact Preference Form (VS 21A)
Official state formAdoptionForm VS 21AFree downloadLast verified November 10, 2026
A birth parent named on an adopted person's original birth certificate uses this form to say whether they want contact, contact through an intermediary, or no contact. It is mailed to the Virginia Office of Vital Records.
Who can use this form
- A birth parent named on the original birth record of an adopted person.
- One form per parent.
- Filing the form is optional.
- A new form may be submitted at any time to update the preference.
What to send with it
- The completed and signed form. All adoptee fields must be filled in.
- A $15 check or money order.
- A readable and clear photocopy of your identification.
- Do not send photos or extra documents. The office does not share or return them.
Where to send it
- Mail to
- Office of Vital Records P.O. Box 1000 Richmond, Virginia 23218-1000
- State fee
- $15 by check or money order, as printed on the form.
- Typical processing
- Not provided
- Form revision
- 07/26
- Source
- Official government page