Family Law Intake Form
Thank you for your interest in Pines Bach LLP, assisting you with your legal needs. This form is used to collect information about potential new clients for internal purposes only. The information you provide will be kept confidential and treated with the utmost discretion. Please note: fees vary among attorneys and the type of representation.
Date
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Month
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Day
Year
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Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pronouns:
*
Please Select
She/Her
He/Him
Them/They
Other
Prior Name(s) if none "N/A":
*
Date of Birth
*
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Month
-
Day
Year
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Preference for communication
*
Please Select
Phone
Email
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
How did you hear about Pines Bach
*
Current Client
Previous Client
Firm Website
Internet Search
Attorney/Judge
Bar Association
Other
Name of Attorney/Judge
Do Not Send Communications to Home Address
Opposing Party Full Legal Name:
*
Opposing Party Date of Birth
*
Prior Name(s) of Opposing Party (if none, N/A)
*
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Are you employed?
*
Please Select
Yes
No
Name of your Employer
*
What is the nature of your matter?
*
Legal Separation
Divorce
Paternity
Post-judgment Modification - Placement/Custody
Post-judgment Modification - Support - Maintenance or Child Support
Enforcement Action
Other
Is this the first marriage for you and your spouse?
Please Select
Yes
No
Do you or your spouse or former spouse/partner have a significant other?
*
Please Select
Yes
No
Names of spouse or significant other(s):
Names of all involved parties, including current spouse/partner, opposing parties' spouse/partner, (if not named above, etc.)
Please describe the matter in which you are seeking legal counsel.
*
Do you, or does your spouse, own a business?
*
Please Select
Yes
No
Name of Business
Are there minor children (18 years old and under)
Please Select
Yes
No
Name of opposing counsel, if any (if none, N/A)
Are there any upcoming court dates?
*
Please Select
Yes
No
Upcoming court dates
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Should be Empty: