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?
*
Please Select
YES
NO
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.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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:
That any information you send us prior to formal engagement should not be confidential or otherwise sensitive information.
That submitting this form does not establish an attorney-client relationship.
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.
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.
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.
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
*
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Print Name
First Name Middle Initial
Last Name
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