Client Intake Form — Frugal Legal Services

How to fill out this form

Lawren D. Burroughs sent you this form so you can share the information we need to start or continue work on your matter. Everything happens in this browser on your device — nothing is uploaded anywhere until you choose to send it back.

Work through each section. Tap a section header to open or close it. Answer what you can; you can always leave a field blank and come back later.
Your progress is saved automatically as you type, in this browser on this device. You can close the tab and return to the same link on the same device to pick up where you left off. If you want to stop at a specific point, tap Save Progress & Continue Later at the bottom of the form to confirm your work is stored.
When you’re done, tap Encrypt & Send Response. Your answers are encrypted on your device and sent directly to Lawren D. Burroughs’s secure inbox. Nothing is readable in transit or by the server — only Lawren D. Burroughs’s app can decrypt it.

A few tips

Use the same device and browser each time so your saved progress is there when you return.
Private or incognito windows will erase your progress when closed — use a regular window.
If you’re unsure about an answer, leave it blank and mention it when you send the file back. Lawren D. Burroughs would rather have a blank than a guess.
Questions about any field? Reach out to Lawren D. Burroughs directly using the contact information at the top of this page.

Your Order ▼

Enter the order number from your purchase receipt and the email address you used at checkout. This lets us match your answers to your order.

Order Number (from your receipt)

Email Address Used at Checkout

Your Contact Information (Petitioner) ▼

You are Petitioner 1 in this adoption. Your full legal name is collected in the Petitioner 1 questions below; please confirm the best contact details for you here.

Phone

Street Address

City

State

ZIP

Close Relative Adoption ▼

This close relative adoption questionnaire collects only the information needed for your petition under Va. Code Ann. § 63.2-1242.1 and the VS-21 Report of Adoption.

Petitioner 1 (You / Close Relative)

Current Legal Name

First Name

Middle Name

Last Name

Suffix

Please check if Petitioner 1's name has been previously changed:

Relationship to Adoptee

Date Petitioner 1 Started Living in the Same Household as the Adoptee

Vital Records Information

Date of Birth

State of Birth

Or Country (if born outside the US)

Race / Ethnicity (VS-21)

Sex (M/F VS-21)

Pronouns

If you select "Other", fill in the five fields below.

Subject

Object

Possessive

Independent Possessive

Reflexive

Current Residential Address

Street

City

State

Zip

Residential Address at the Adoptee's Birth

Required by Vital Records to be reported on the VS-21.

Street

City

State

Zip

Petitioner 2 (Second Petitioner / Close Relative or Spouse of Petitioner 1)

If there is more than one Petitioner, each Petitioner must fill out this section separately. If Petitioner 1 is married, Petitioner 2 should fill out this section separately as Petitioner 2.

Is there a second petitioner?

Current Legal Name

First Name

Middle Name

Last Name

Suffix

Please check if Petitioner 2's name has been previously changed:

Relationship to Adoptee

Date Petitioner 2 Started Living in the Same Household as the Adoptee

Vital Records Information

Date of Birth

State of Birth

Or Country (if born outside the US)

Race / Ethnicity (VS-21)

Sex (M/F VS-21)

Pronouns

If you select "Other", fill in the five fields below.

Subject

Object

Possessive

Independent Possessive

Reflexive

Current Residential Address

Street

City

State

Zip

Residential Address at the Adoptee's Birth

Required by Vital Records to be reported on the VS-21.

Street

City

State

Zip

First Birth or Adoptive Parent

Complete the following section. This person is required to cooperate with the adoption by executing consent forms. This information is also required by Vital Records to be reported on the VS-21.

Current Legal Name

First Name

Middle Name

Last Name

Suffix

Please check if this parent's name has been previously changed:

Relationship to Adoptee

Vital Records Information

Date of Birth

State of Birth

Or Country (if born outside the US)

Race / Ethnicity (VS-21)

Sex (M/F VS-21)

Pronouns

If you select "Other", fill in the five fields below.

Subject

Object

Possessive

Independent Possessive

Reflexive

Current Residential Address

Street

City

State

Zip

Second Birth or Adoptive Parent

Complete the following section. This person is required to cooperate with the adoption by executing consent forms. This information is also required by Vital Records to be reported on the VS-21.

Current Legal Name

First Name

Middle Name

Last Name

Suffix

Please check if this parent's name has been previously changed:

Relationship to Adoptee

Vital Records Information

Date of Birth

State of Birth

Or Country (if born outside the US)

Race / Ethnicity (VS-21)

Sex (M/F VS-21)

Pronouns

If you select "Other", fill in the five fields below.

Subject

Object

Possessive

Independent Possessive

Reflexive

Current Residential Address

Street

City

State

Zip

Adoptee (Child)

This section is for the child being adopted. If the adoptee is over 14 years old, they must consent to the adoption.

Current Legal Name

First Name

Middle Name

Last Name

Suffix

Please check if the adoptee's name has been previously changed:

Will the adoptee be changing their name as a result of this adoption?

Pronouns

If you select "Other", fill in the five fields below.

Subject

Object

Possessive

Independent Possessive

Reflexive

Vital Records Information

Date of Birth

State of Birth

Or Country (if born outside the US)

Birth Certificate Number

Race / Ethnicity (VS-21)

Sex (M/F VS-21)

Additional Parties ▼

Add anyone else connected to this adoption — a birth mother, birth father, adoptive mother or father, a birth parent or adoptive parent (any gender), a known donor, an anonymous donor (by donor number), or the cryobank. Add a party even if you only know part of their information.

Frugal Legal Services

How to fill out this form

A few tips

Current Legal Name

Vital Records Information

Current Residential Address

Residential Address at the Adoptee's Birth

Current Legal Name

Vital Records Information

Current Residential Address

Residential Address at the Adoptee's Birth

Current Legal Name

Vital Records Information

Current Residential Address

Current Legal Name

Vital Records Information

Current Residential Address

Current Legal Name

Child's New Name

Vital Records Information