INSTRUCTIONS: CONTACT PREFERENCE AND MEDICAL HISTORY FORM FOR BIRTH PARENT(S) OF ADOPTED CHILDREN BORN IN ALABAMA (Form ADPH-HS-87)

The form discussed in this article is used by Alabama birth parents who give up their children for adoption to document their contact preferences and medical history. This form can be obtained from the website maintained by the Alabama Department of Public Health.

Contact Preference And Medical History Form For Birth Parent(s) Of Adopted Children Born In Alabama ADPH-HS-87 Step 1: Indicate whether you are the birth mother or father with a check mark and enter the date of completion of this form.

Contact Preference And Medical History Form For Birth Parent(s) Of Adopted Children Born In Alabama ADPH-HS-87 Step 2: Enter the date of the child's birth on the next blank line.

Contact Preference And Medical History Form For Birth Parent(s) Of Adopted Children Born In Alabama ADPH-HS-87 Step 3: Indicate whether the child is male or female with a check mark.

Contact Preference And Medical History Form For Birth Parent(s) Of Adopted Children Born In Alabama ADPH-HS-87 Step 4: Enter the county or city or birth on the next blank line.

Contact Preference And Medical History Form For Birth Parent(s) Of Adopted Children Born In Alabama ADPH-HS-87 Step 5: Enter the mother's name as it appears on the birth certificate on the next blank line.

Contact Preference And Medical History Form For Birth Parent(s) Of Adopted Children Born In Alabama ADPH-HS-87 Step 6: If you would like to be contacted, indicate this with a check mark. If so, enter your current name, complete address, telephone number, and any other pertinent contact information.

Contact Preference And Medical History Form For Birth Parent(s) Of Adopted Children Born In Alabama ADPH-HS-87 Step 7: If you would only like to be contacted through an intermediary, indicate this with a check mark.

Contact Preference And Medical History Form For Birth Parent(s) Of Adopted Children Born In Alabama ADPH-HS-87 Step 8: If you would prefer not to be contacted at this time, indicate this with a check mark.

Contact Preference And Medical History Form For Birth Parent(s) Of Adopted Children Born In Alabama ADPH-HS-87 Step 9: On the next three pages, provide all information requested about your family medical history.