FAMILY LAW INTAKE

Please fill out this questionnaire. It is important that you answer each question fully because your attorney will use this information to prepare your case. Your responses to these questions will help to organize your case and allow our firm to better represent you. If a question does not apply to your particular situation, please indicate by marking the question “N/A”. Your answers are protected by confidentiality and by the attorney-client privilege, but please note that a legal consultation does not establish on ongoing attorney-client relationship and that neither the attorney nor you have any obligation to accept or offer any additional services. You are free to have the presence of a third party (or parties) present during your consultation, but please note that doing so constitutes your waiver of attorney-client privilege as to anything discussing during the consultation, meaning that anything discussed could potentially be discoverable in litigation. NOTE: There is a flat fee of $200.00 for the initial, forty-five (45) minute consultation. If you have any questions about this fee, please discuss it with the attorney before beginning the consultation. I understand that a legal consultation does not establish an ongoing attorney-client relationship and that neither the attorney nor I have any obligation to accept or offer any additional services. I understand that the presence of a third party during this consultation constitutes a waiver of attorney-client privilege as to anything discussed during this consultation and that anything discussed could be potentially discoverable in litigation. I understand and agree that the firm charges a flat fee of $200.00 for the initial, forty-five (45) minute consultation. I agree to pay said fee before the start of the initial consultation. I understand that if a do not retain the attorney within 60 days of this consultation, a second consultation may be required.
Signature is required.

Prospective Client Info

Opposing Party Info

Marriage Information

(Concerning the Marriage out of which your Present Issues Arise)

Children

(Including those Children Not Involved in the Present Issue)
1. FULL NAME; 2. AGE; 3. SEX: 4. FATHER: 5. On Birth Certificate:
Child Custody
1. DATE OF OTHER: 2. COUNTY OF ORDER: 3. TERMS:
Child Support
1. DATE: 2. COUNTY OF ORDER: 3. AMOUNT PER MONTH:

Property Distribution

(assets, debts, inheritances, etc., that will need to be distributed pursuant to divorce/separation)
Martial Residence
1. Titled To: 2. Year Purchased: 3. Value: 4. Mortgage Balance: 5. Person(s) on Mortgage
Please include the following information: 1. Titled To; 2. Property Address; 3. Market Value; 4. Mortgage Balance
To Whom and What is the Anticipated Amount?
Please include the following information: 1. Account Name & 2. Approximate Balance for Each Debt
Other Case Info
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