Virginia Divorce Client Intake
Answer the questions for you and your spouse, then review your entries before exporting your submission.
About You
Will you be the spouse filing for divorce?
*
Yes
No
Your name
*
First Name
Middle Name
Last Name
Name suffix
Please Select
Jr.
Sr.
II
III
IV
V
Other
Date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
National identifier
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
*
example@example.com
Street address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
City
*
State
*
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
DC
ZIP code
*
Honorific
Please Select
Mr.
Ms.
Mrs.
Mx.
Dr.
Prof.
Other
Pronouns
She/Her
He/Him
They/Them
Other
Did you change your name because of this marriage?
*
Yes
No
Former name
Birth name
Have you had any other prior legal name changes?
Yes
No
Prior name-change history
Should the divorce decree restore your former name?
Yes
No
Preferred contact method
*
Please Select
Phone
Email
Mail
Text message
Other
How did you hear about us?
Please Select
Attorney referral
Search engine
Social media
Friend or family
Court or legal aid
Website
Other
Your Spouse
Spouse's Full Name
*
First Name
Middle Name
Last Name
Name Suffix
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
National Identification Number
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Street Address
*
City
*
State
*
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Other
ZIP Code
*
Honorific
Please Select
Mr.
Mrs.
Ms.
Mx.
Dr.
Other
Pronouns
She/Her
He/Him
They/Them
Other
Former Name
County of Residence
Residency
Are you a Virginia domiciliary?
*
Yes
No
Is your spouse a Virginia domiciliary?
*
Yes
No
Your Virginia residency duration
Less than six months
Six months or longer
If not, what state do you reside in outside Virginia?
If not, what country do you reside in outside the United States?
Please Select
United States
Canada
Mexico
Other
Spouse's Virginia residency duration
Less than six months
Six months or longer
Military
Are you currently serving in the military?
*
Yes
No
Your military branch
Please Select
Army
Navy
Air Force
Marine Corps
Space Force
Coast Guard
Other
Your military service status
Please Select
Active Duty
Reserve
National Guard
Retired
Separated
Other
Your military service start date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Your military duty station
Are you stationed in Virginia?
Yes
No
Have you been stationed there for at least six months?
Yes
No
Your military station city
Your military station state or country
Are you eligible for 20/20/20 military-spouse benefits?
Yes
No
Not sure
Are you receiving Survivor Benefit Plan benefits?
Yes
No
Not sure
Is your spouse currently serving in the military?
*
Yes
No
Your spouse's military branch
Please Select
Army
Navy
Air Force
Marine Corps
Space Force
Coast Guard
Other
Your spouse's military service status
Please Select
Active Duty
Reserve
National Guard
Retired
Separated
Other
Your spouse's military service start date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Your spouse's military duty station
Is your spouse stationed in Virginia?
Yes
No
Has your spouse been stationed there for at least six months?
Yes
No
Your spouse's military station city
Your spouse's military station state or country
Is your spouse eligible for 20/20/20 military-spouse benefits?
Yes
No
Not sure
Is your spouse receiving Survivor Benefit Plan benefits?
Yes
No
Not sure
Marriage
Date of marriage
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
City or county where married
*
State or country where married
*
Date of separation
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
City or county where separated
*
State or country where separated
*
Have you continuously lived separate and apart since the separation date?
*
Yes
No
Do you intend the separation to be permanent?
*
Yes
No
Qualifying separation period
*
Six months
One year
Grounds for divorce
*
No-fault separation
Possible fault grounds
Describe the fault grounds
Agreement status
*
We have a signed agreement
We are asking the firm to draft an agreement
Other
Date the agreement was signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you proceeding without an agreement?
Yes
No
If proceeding without an agreement, how should these issues be handled?
Rows
By agreement
By court decision
Undecided
Property division
Spousal support
Custody/Parenting
Custody arrangement
Joint legal custody
Joint physical custody
Primary physical custody to one parent
Shared custody
Other
Parenting-time arrangement
Equal time schedule
Primary schedule with one parent
Alternating weekends
Custom schedule
Other
Is there a regular parenting schedule?
Yes
No
Overall parenting schedule
Regular pickup time
Hour Minutes
AM
PM
AM/PM Option
Regular drop-off time
Hour Minutes
AM
PM
AM/PM Option
Exchange location
Holiday schedule
Summer and school-break schedule
Include a right of first refusal?
Yes
No
Right of first refusal trigger hours
Relocation restriction
No relocation restriction
Advance notice required
Court approval required
Other
Parent-child communication schedule
Child Support
Child support status
Agreed
Reserved
Contested
Child support payor
Please Select
You
Spouse
Child support payee
Please Select
You
Spouse
Agreed monthly child support amount
Presumptive guideline child support amount
Child support basis
Guideline
Deviation from guideline
Reason for child support deviation
Child support payment schedule
One payment per month
Two equal payments per month
First child support payment day
Second child support payment day
Child support start date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Child support payment method
Directly to the other parent
Through DCSE
Direct-payment details
DCSE case number
Who pays child health insurance
Monthly child health insurance amount
Who pays child dental insurance
Monthly child dental insurance amount
Who pays child vision insurance
Monthly child vision insurance amount
Who pays work-related childcare
Monthly work-related childcare amount
Your tax-dependency years
Spouse's tax-dependency years
Your child-support certification statement
Spouse's child-support certification statement
Reserve child support
Yes
No
Child Support Arrearage
Child-support arrearage status
No arrearage exists
I owe my spouse
My spouse owes me
Total child-support arrearage
Arrearage period start date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Arrearage period end date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Interest on arrearage
Arrears payment schedule
One-time payment
Monthly payments
Other
Monthly payment amount
Payment day(s) of the month
Payment start date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Payment method
Direct payment
Through the Division of Child Support Enforcement
Other
Spousal Support
Spousal-support status
*
Agreed
Reserved
Waived
Contested
Spousal-support payor
First Name
Middle Name
Last Name
Spousal-support payee
First Name
Middle Name
Last Name
Spousal-support monthly amount
Spousal-support payment schedule
Please Select
Weekly
Biweekly
Semimonthly
Monthly
Quarterly
One-time
Other
Spousal-support payment days
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Spousal-support start date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Spousal-support payment type
Periodic
Lump sum
Installments
Spousal-support modifiability
Modifiable
Nonmodifiable
Unknown
Spousal-support payment details
Spousal-support conditional lump-sum or installment terms
Spousal-support termination conditions for payor
Spousal-support termination conditions for payee
Spousal-support arrearage status
No arrears
Arrears exist
Unknown
Health Benefits
Will you provide health insurance coverage for your spouse or children?
*
Yes
No
Unsure
Will your spouse provide health insurance coverage for you or the children?
*
Yes
No
Unsure
Will each spouse provide their own health insurance?
*
Yes
No
Unsure
Will your spouse provide military health benefits?
Yes
No
Unsure
Property
Are all property and debts fully resolved?
*
Yes
No
Does either you or your spouse own any real property?
*
Yes
No
Marital residence nickname
Marital residence street number and name
Marital residence city, state, and ZIP
Marital residence title holder
Marital residence current value
Marital residence mortgage balance
Marital residence monthly mortgage payment
Marital residence mortgage payor
Marital residence disposition
Please Select
Sell and divide net proceeds
Hold as tenants in common
You buy out spouse
Spouse buys you out
You retain and spouse waives
Spouse retains and you waive
Reserved to court
Marital residence deadline
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Marital residence buyout amount
Marital residence Party 1 percent or dollar proceeds
Marital residence Party 2 percent or dollar proceeds
Marital residence listed debts paid from sale proceeds?
Yes
No
Number of investment properties
Investment Property 1 type
Investment Property 1 address
Investment Property 1 title holder
Investment Property 1 current value
Investment Property 1 mortgage balance
Investment Property 1 monthly rent
Investment Property 1 occupant
Investment Property 1 disposition
Please Select
Sell and divide net proceeds
Hold as tenants in common
You buy out spouse
Spouse buys you out
You retain and spouse waives
Spouse retains and you waive
Reserved to court
Investment Property 1 notes
Number of vehicles
Number of other assets
Number of debts
Reserve equitable distribution for later?
Yes
No
Waive equitable distribution?
Yes
No
Retirement
How many retirement accounts do you have?
*
Retirement Account 1 Type
Please Select
401(k)
403(b)
Pension
IRA
Roth IRA
Thrift Savings Plan
Deferred Compensation
Other
Retirement Account 1 Owner / Plan Holder
Retirement Account 1 Institution
Retirement Account 1 Approximate Value
Retirement Account 1 Disposition
Please Select
Keep
Divide
Transfer
Offset with Other Assets
Waive Interest
Other
Retirement Account 1 Division Method
Please Select
Equal Share
Percentage
Fixed Amount
QDRO
Other
Retirement Account 1 Division Amount / Percentage
Retirement Account 1 Equalization Amount and Date
Retirement Account 1 Plan Administrator / Account Number
Retirement Account 1 Coverture Dates
Military Pension Election
Please Select
Not Applicable
Waive All Retirement Interests
Accept Share of Military Pension
Reserve Right to Decide Later
Other
Review
Please review your answers carefully and make any corrections before continuing.
Is there anything else we should know about your case?
I certify that, to the best of my knowledge, this intake is complete and accurate, and I understand it will be reviewed by an attorney.
*
I certify completeness and accuracy
I acknowledge attorney review
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