Virtulaw Client Intake Form

Virtulaw Client Intake Form

Client Intake
Information:
Client's Name:

First NameMiddle NameLast Name
Spouse's Name:

First NameMiddle NameLast Name
Client's Phone Number
Format: (000) 000-0000.
Client's E-mail
example@example.com
Client's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Spouse's Phone Number
Format: (000) 000-0000.
Spouse's E-mail
example@example.com
Spouse's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Separation

MonthDayYear
Date of Marriage

MonthDayYear
Would you or your spouse like to restore a former name?
Former name (include middle name)
Have you or your spouse lived in California for at least six months?
Have you or your spouse lived in this county for the last three months?
Party to pay spousal support (Self, Spouse or Waived)

Other
Party to pay child Support (Self, Spouse or Other)

Other
Are you filing for divorce or separation?
Is spouse in active Military?
Are you receiving public assistance?
Is your spouse receiving public assistance?

Other
Are you and your spouse in agreement on all major issues?

Other
Child Information:

Children

Rows	Name	Age	Date of Birth	City of Birth	Sex
Child 1
Child 2
Child 3
Child 4

Will you share joint physical custody?

Other
Children's residential history for the prior 5 years (include dates & addresses):
State the current custodial arrangements and any preferences or agreements regarding custody of the children.
List any questions you would like to discuss.
Upload Files

Cancelof
Should be Empty: