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
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Consultation Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
First Name
Last Name
Cell Phone
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Email
example@example.com
What is the best way to reach you?
Email
Phone
Work
Type Of Case
County of Residence
How Long in this County?
Please Complete the following information on YOURSELF
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Place of Birth
Social Security Number
Drivers License No
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employment Information
Employer
Title
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gross Salary Per Month
Length of Employment
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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 Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Address
Street Address
Street Address Line 2
City
State / 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:
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PLEASE COMPLETE THIS SECTION REGARDING THE CHILDREN INVOLVED IN THIS CASE
Child 1
Child 1
Child 2
Child 3
Child 4
Is private health insurance in effect for the children
Is the insurance coverage provided through a parent's employment
If so, which parent?
Amount of Premium
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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
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Please provide any additional information you feel would be helpful for the attorney preparing for your initial client consultation?
Consultation Fee- $200
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USD
Consultation Fee
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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