New Client Questionnaire (Family Law)

Family Law Consultation Questionnaire

Your initial consultation is a very important phase of your case. At this consultation, you will give your prospective attorney some general facts and an overview of your case.
Your Full Legal Name *

First Name Middle Initial Last Name, Suffix
Do you go by a nickname? If yes, provide below.
List any maiden or prior marital names
Date of Birth *

Month Day Year
Date
What is your current Marital Status? *

Single, never married Married Divorced Legally Separated Widowed
Date of Marriage (if applicable)

Month Day Year
Date
Are you currently separated? *
To be considered legally separated from your spouse, you need to be living in different homes, and at least one of you needs to intend that the separation be permanent. In general, you are not legally separated if your relationship has ended but you still live in the same home, or if you live in separate homes without the intent to be permanently separated (for example, for work purposes).
If Yes, what is your date of Separation?

Month Day Year
Date
Contact Information

Do not provide addresses, phone numbers, or emails below that the opposing party can access.
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
What county do you currently live in? *
Have you lived in the above county for more than 6 months?

Yes No
Is your mailing address different from the one provided above?

Yes No
If Yes, provide Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Primary Phone # *
Please enter your primary phone number.
Primary Phone # Type *

Cell Home Work Other
Email *
DO NOT provide an email account that the opposing party may be able to access.
Preferred Method of Communication *

Email Phone
Emergency Contact

Please provide contact information for someone you authorize Regent Law to contact regarding your case in the event we are unable to reach you.
Name

First Name Last Name
Relationship to you:
e.g., mother, father, sister, friend, etc.
Phone Number
Please enter a valid phone number.
Email
example@example.com
Conflicts of Interest
Full Legal Name of Primary Opposing Party *
First Name MI Last Name or Company Name, if applicable
Does the opposing party go by a nickname? If yes, provide below.
Address of Primary Opposing Party (if known)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
In what county does the primary opposing party reside? *
You may type Unknown, if necessary.
Are there Additional Opposing Parties? *

Yes No
Please list the name, address and brief explanation of any person who will be an additional opposing party.
Please list the full name and provide a brief explanation of any person or entity, not already provided above, that you think may have a conflict of interest with you with regard to our office handling your case. Please give all names a person/entity may have used. *
If NONE, so indicate.
Does the opposing party currently have an attorney? *

Yes No I don't know
Name of current opposing attorney *
Include name of specific attorney / law firm.
General Case Information
Please check all issues that are or may be involved in your case. *

Absolute Divorce (In North Carolina, “absolute divorce” signifies nothing more than the termination of the marriage bond that was created by your wedding ceremony and marriage certificate.) Property Settlement (aka Equitable Distribution) Child Custody Child Support Alimony/Post-Separation Support Marital Misconduct (e.g., illicit sexual behavior, alcohol/drug abuse, etc.) Domestic Violence Other (Please explain below)
Briefly provide an explanation of the issues involved in your case or matter for which you are seeking counsel. What are your top goals and objectives? *
Does your matter involve minor children? *

Yes No
Minor Children: Please provide full legal names, date of birth, and who each child lives with.
Are there any existing court orders, separation agreements, pre or post marital agreements related to these issues? *

Yes No
If existing court order, which county was the order entered?
Enter County and file #, if available.
If Yes, please upload copies of these documents, if available.

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Is there currently a pending court case regarding these issues? (e.g., Have you been served with pleadings, lawsuits, subpoenas, papers by the sheriff or papers by certified mail?) *

Yes No
If Yes, please upload copies of these documents, if available.

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If Yes, what county is your case currently filed in?
If Yes, is there a pending hearing date?

Yes No I'm not sure
Pending Hearing Date

Month Day Year
Date
Do you currently have an attorney for this matter? *

Yes No, never. Not currently, but I have previously had an attorney for this matter.
If Yes, please provide the attorney's name and firm name?
Employment Information
Are you currently employed? *

Yes No
If you are not employed, when and where did you last work?
Provide name, position, and approximate dates of employment
Position/Occupation
Employer Name
Employer Address

Street Address

Street Address Line 2

City State
Employer Phone #
Please enter a valid phone number.
Gross Annual Salary or Income
Estimate should Include all base salary, commissions, bonuses, etc.
Miscellaneous Information
How did you hear about us? (Check all that apply) *

Referred by someone Online Search (e.g., Google, Bing, Yahoo) Website Thumbtack ARAG MetLife Legal Plans Facebook Instagram Other
Were you referred to us by someone?

Yes No
If someone referred you, what is their name?

First Name Last Name
Can we send them a thank you note?

Yes No
Acknowledgment

By signing below and submitting this form you acknowledge the following:
1. That any information you send us prior to formal engagement should not be confidential or otherwise sensitive information.
2. That submitting this form does not establish an attorney-client relationship.
3. We cannot provide representation until we have had an opportunity to evaluate your case, including but not limited to an evaluation of whether we are in a conflict position to represent you.
4. That third parties will not be allowed to be present during your initial consultation, subsequent meetings or calls without prior approval. If you require a third party to be present, please call our office to discuss after submitting this form.
5. We ask that you do not sign anything with the opposing party pending your initial consultation and that you not change your living conditions (ie: move out of your residence) unless there is domestic violence.
6. If there is domestic violence of any type and you have not already done so, call our office at 704-315-2691 and ask for a special appointment immediately. This is regardless of whether you are the victim or the alleged perpetrator of domestic violence (domestic violence is frequently and wrongfully used as leverage in a case).
I have read the above acknowledgments. (Required) *

Yes
By signing below, you acknowledge that unless you formally retain Regent Law that completing this form does not create a client-lawyer relationship and the information provided may not be considered privileged or confidential.

Yes
I understand that third parties will not be allowed to be present during my initial consultation or subsequent meetings or calls without prior approval. If you require a third party to be present, please call our office to discuss after submitting this form.

Yes
Signature *

Clear
Print Name

First Name Middle Initial Last Name
Should be Empty:

Family Law Consultation Questionnaire

Contact Information

Emergency Contact

Conflicts of Interest

General Case Information

Employment Information

Miscellaneous Information

Acknowledgment