Intake Form: Family Law

About You

Name*

First NameMiddle NameLast Name

Social Security Number*

State of Birth*

Street Address

Street Address Line 2

State

Date of Birth*

MonthDayYear

Driver's License Number

Primary Phone*

Area CodePhone Number

Alternate Phone

Area CodePhone Number

E-mail Address*

Confirmation Email

Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code

Is your physical address the same as your mailing address?*

YesNo

Physical Address

Street Address

Street Address Line 2

CityState

Zip Code

Are you currently employed?*

YesNo

Employer*

Position*

Employer's Address

Street Address

Street Address Line 2

CityState

Zip Code

Marital Status*

Date of Marriage*

MonthDayYear

Date of Separation*

MonthDayYear

Maiden Name

Place of Marriage*

About the Other Party

Name*

First NameMiddle NameLast Name

Social Security Number

State of Birth

Street Address

Street Address Line 2

State

Date of Birth

MonthDayYear

Driver's License Number

Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code

Is his/her physical address the same as his/her mailing address?*

YesNo

Physical Address

Street Address

Street Address Line 2

CityState

Zip Code

Is he/she currently employed?*

YesNo

Employer

Position

Employer's Address

Street Address

Street Address Line 2

CityState

Zip Code

About Your Children

Do you have any children?*

YesNo

How many children do you have?*

1234+

First Child

Name*

First NameLast Name

Sex*

MaleFemale

Date of Birth*

MonthDayYear

Place of Birth*

Social Security Number*

Second Child

Name*

First NameLast Name

Sex*

MaleFemale

Date of Birth*

MonthDayYear

Place of Birth*

Social Security Number*

Third Child

Name*

First NameLast Name

Sex*

MaleFemale

Date of Birth*

MonthDayYear

Place of Birth*

Social Security Number*

Fourth Child

Name*

First NameLast Name

Sex*

MaleFemale

Date of Birth*

MonthDayYear

Place of Birth*

Social Security Number*

Other Pertinent Information

Have you / your spouse resided in the State of Texas for at least six months?*

YesNo

Which county have you / your spouse resided in for the last 90 days?*

Have your children resided in the State of Texas for at least six months?*

YesNo

Which county have your children resided in for the last 90 days?*

Are you, your spouse, or your children currently the subject of a Family Violence Protective Order, or has an application for such an order been filed?*

YesNo

Date*

MonthDayYear

Cause Number*

Court*

Have any prior orders for conservatorship, possession and access, or support of your children been entered by any Court? *

YesNo

Date*

MonthDayYear

Cause Number*

Court*

Was the Attorney General a party to the suit?*

Are you obligated to support any children who will not be the subject of this case? *

YesNo

How many?*

What type of action are you requesting? Select all that apply.*

Please give a detailed case description.

NOTICE OF CONFIDENTIALITY

THE INFORMATION IN THIS DOCUMENT IS SUBJECT TO THE ATTORNEY CLIENT PRIVILEGE AS PROVIDED IN THE TEXAS RULES OF EVIDENCE. HOWEVER, IF A PROFESSIONAL, INCLUDING AN ATTORNEY OR AN EMPLOYEE OF AN ATTORNEY, HAS CAUSE TO BELIEVE THAT A CHILD HAS BEEN ABUSED OR NEGLECTED OR MAY BE ABUSED OR NEGLECTED OR THAT A CHILD IS A VICTIM OF AN OFFENSE UNDER SECTION 21.11 OF THE TEXAS PENAL CODE, AND THE PROFESSIONAL HAS CAUSE TO BELIEVE THAT THE CHILD HAS BEEN ABUSED AS DEFINED BY SECTION 261.001 OR 261.401 OF THE TEXAS FAMILY CODE, THE PROFESSIONAL SHALL MAKE A REPORT NOT LATER THAN THE FORTY-EIGHTH HOUR AFTER THE HOUR THE PROFESSIONAL FIRST SUSPECTS THAT THE CHILD HAS BEEN OR MAY BE ABUSED OR NEGLECTED OR IS A VICTIM OF AN OFFENSE UNDER SECTION 21.11 OF THE TEXAS PENAL CODE. THE REPORT SHALL BE MADE TO THE APPROPRIATE AGENCY.

THE CONTENTS OF THIS DOCUMENT CONSTITUTE ATTORNEY WORK PRODUCT.

THE CONTENTS OF THIS DOCUMENT ARE CONFIDENTIAL AND ARE NOT TO BE DISCLOSED TO THIRD PERSONS OTHER THAN THOSE TO WHOM DISCLOSURE IS MADE IN FURTHERANCE OF THE REDITION OF PROFESSIONAL LEGAL SERVICES.

Privacy Policy Regarding Social Security Numbers:

Social Security numbers will be divulged only when necessary during the course and within the scope of our employment. Social Security numbers are collected by the firm from various sources, including income tax returns as well as the client.

Social Security numbers are used to identify parties for a number of purposes, including determination of wagers preparation of orders to withhold wages for child support and reports filed with the state of Texas, and obtaining information about retirement benefits.

All information received from our clients is confidential, particularly Social Security numbers. Social Security numbers are not divulged by the firm unless authorized by the client or required in the course of representation.

Only employees of the firm who have a need to know will have access to this personal information.

Every step is taken to protect the client’s privacy. This information is kept secure within the office of the firm in file folders and file drawers, until the file information is retired and the file is removed to a locked, off-site storage facility. Client information will eventually be shredded.

Please take the time to go over the information that you have provided and make sure that it is correct.

By signing below, you are agreeing that all information you have given in this questionnaire is true and correct to the best of your knowledge. Please notify us of any and all changes that occur at your earliest convenience.

Signature*

Date*

MonthDayYear