Intake Form

*Name:

*Home Phone:

Cell Phone:

Work Phone:

*E-mail address:

Fax:

*Address:

*City:

*State:
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*Zip:

How did you hear about us?:

What type of family law matter are you interested in? (Ctrl-Click to select multiple answers)
Choose One Adoption Alimony Support Annulment Child Custody Child Support Cohabitation Civil Union Divorce Dissolution Domestic Partnership Domestic Violence Modifications Divorce Decree International Adoption Legal Separation Postnuptial Agreement Prenuptial Agreement Protective Order Visitation Other

If Other, please describe the type of family law you are interested in:

If case is already in progress:

Case Number:

Case Name:

Your Current Counsel:

What is your relationship with the opposing party?
Choose One Spouse Former Spouse Cohabitant Co-parent Other Relationship Other

If Other Relationship, please explain:

Name of Opposing Party:

Opposing party's occupation, employer and annual earnings:

Opposing party's counsel, if any:

Have other attorneys worked on this matter?
Yes  No 

If yes, provide names, addresses, and a brief description of their involvement:

What is the current status of the case?:

Have you been served or served the opposing party with papers in a family law matter?
Yes  No 

If yes, describe:

Have you had any hearings?
Yes  No 

Are there any hearings scheduled?
Yes  No 

Do you have copies of any documents (court decrees, dissolution agreements, etc.) related to this matter?
Yes  No 

What types of documents do you have?

Is domestic violence an issue in this matter?
Yes  No 

If you have children:

Number of Children and ages:

With whom and where do they live?

Are you or any person involved in this matter currently pregnant?
Yes  No 

Are you currently married or cohabitating?
Yes  No 

If yes, list his or her name, date of birth, and date of marriage/cohabitation:

Is there a Pre-Nuptial agreement?
Yes  No 

If so, describe its terms:

Are there any assets of the marriage (i.e., house, cars)?
Yes  No 

Estimated value of assets:

Total Estimated Value of Community Property:

Do you have any concerns regarding separate property?
Yes  No 

Is property an issue?
Yes  No 

If yes, please describe the property and anything known with regard to legal ownership:

Your occupation, employer and annual earnings:

Were you previously married?
Yes  No 

If yes, when and how did your previous marriage(s) end?

Is your case contested or do you anticipate you will meet opposition to your anticipated actions?

Describe how this situation has impacted you:

Describe what you would like to happen to resolve your issue (your preferred outcome):

Special concerns or issues: