Intake Screener Questionnaire

Intake Screener Questionnaire
Submitting this intake form does not create an attorney-client relationship. An attorney-client relationship is formed only after a conflict check is completed and a written engagement agreement is signed by both parties.

Please do not include highly sensitive personal information (such as Social Security numbers, bank account numbers, or detailed financial records) at this stage.

Submission of this form does not guarantee representation. If I believe your matter may not be a good fit for my practice, I will notify you promptly.

If your matter proceeds to consultation, the initial 30-minute consultation fee is $50. Payment is required at the time of scheduling in order to confirm your appointment.
Please confirm that you have read and understand the above information.*

I understand and agree.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Opposing Party Name*

First NameLast Name
County where matter is filed or expected to be filed*
What is the primary issue you need assistance with right now?*

DivorceCustodyProtection from Abuse (PFA)SupportOther
Are there additional related matters involved (e.g., custody, support, PFA)?

YesNo
Briefly identify which additional matters are involved.

Divorce Intake Information