Family Law Intake (W/ Consult Fee)

Initial Client Information Sheet

The information you furnish in this questionnaire is confidential. It is important for you to answer all questions as fully and completely as possible.
Todays Date

MonthDayYear
Date
Consultation Date

MonthDayYear
Date
Name

First NameLast Name
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Email
example@example.com
What is the best way to reach you?
Type Of Case
County of Residence
How Long in this County?
Please Complete the following information on YOURSELF
Date of Birth

MonthDayYear
Date
Age
Place of Birth
Social Security Number
Drivers License No
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment Information
Employer
Title
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gross Salary Per Month
Length of Employment

Please complete the following information on the OPPOSING PARTY

Please fill this out to the best of your ability, if you cannot provide the information at this time please leave blank.
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What kind of vehicle does he/she currently drive?
Brief Physical Description of Opposing Party
Employer
Job Title
Length of Employment
Gross Monthly Salary
Normal Work Hours
Has Opposing Party caused any family violence in the past? If so, please list all dates and a brief description of each incident:
Does he/she have a criminal record? If so please specify below:

Additional Children
Do you have any other children? If so, how many
Do you or opposing party have any other children for whom you are ordered to pay child support? If so please list?
Additional Child
Additional Child

Please provide any additional information you feel would be helpful for the attorney preparing for your initial client consultation?

USDConsultation Fee

Initial Client Information Sheet