Contact Us

First Name

Last Name

Address

City

State

Zip Code

Phone Number
(1 # Required)

Cell

Home

Work

Best Time to Call

Your Cell

Your Home

Your Work

How were you referred to our office?

Phone Book

Friend of Relative: Name

Other

Type Of Matter (check all that apply)

If you have selected divorce, separation, collaborative, annulment or maintenance, please answer the following question:

If this issue involves a relationship with another party, the relationship is

If you have selected Heterosexual, the following questions apply:

If Married, Date of Marriage

If Divorced, Date of Divorce

How many children do you have with your current spouse?

Name

Date of Birth

Living With

Name

Date of Birth

Living With

Name

Date of Birth

Living With

Name

Date of Birth

Living With

How many children do you have from previous relationships?

Do you own a home?

To whom is your home titled?

Are you living together?

Do you have joint bank accounts?

Do you have joint credit cards?

Are you employed?

If yes, where?

Approximate yearly income?

Is your spouse employed?

If yes, where?

Approximate yearly income?

Is there domestic abuse in your home?

If yes, who is the victim?

If yes, who is the abuser?

Please give a brief summary of your needs and expectations.

If you have selected Same-Sex, the following questions apply:
Where were you legally married?

State

Date

What is the date of separation from your partner?

What are the legal issues involved? (check all that apply)

How many children were adopted or born of the relationship?

Name

Date Of Birth

Living With

Name

Date Of Birth

Living With

How many children do you have from previous relationships?

Do you own a home?

To whom is your home titled?

Are you living together?

Do you have joint bank accounts?

Do you have joint credit cards?

Are you employed?

If yes, where?

Approximate yearly income?

Is your spouse employed?

If yes, where?

Approximate yearly income?

Is there domestic abuse in your home?

If yes, who is the victim?

If yes, who is the abuser?

Please give a brief summary of your needs and expectations.

If you have selected child custody, visitation, child support, paternity or adoption, the following apply:

How many children do you have?

Date of Birth

Living With

How many children do you have from previous relationships?

Is there a custody order currently in place?

Are you employed?

If yes, where?

Approximate yearly income?

Is your spouse employed?

If yes, where?

Approximate yearly income?

Is there domestic abuse in your home?

If yes, who is the victim?

If yes, who is the abuser?

Please give a brief summary of your needs and expectations.

If you have selected the will or estate, the following applies:

If your matter involves a will, power of attorney, living will or health care proxy, state whether there is any critical timing issues and why (example: illness, taking a trip, etc.)

If your matter involves an Estate, state the name and relationship of the deceased and what type of matter, if any, is pending:

If you have selected the real estate option, the following applies:
If your matter involves real estate:

Are you purchasing?

Are you selling?

List the location of the properties involved.

If you have selected the personal injury, malpractice or defective products option, the following applies:
If your matter involves personal injury accident or defective products, give the following:

Date of occurrence

Who was injured

Nature of injury

Is the victim seeking medical treatment?

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