Confidential Family Law Intake Form

Please complete the form below to provide information regarding your family law matter. The details you share will help our office review your case and determine next steps. All information submitted through this form is kept confidential.

Opposing Party Information:

First Name:

Last Name:

Address:

Phone:

Email:

DOB:

Social Security No:

Driver's License No:

Employment information of Opposing Party:

Employer:

Job Title:

Gross Salary / Month:

For all children of this relationship, please provide the following information:

Child 1:

Name:

Sex:

DOB:

Place of Birth:

Currently Resides With:

Please provide residence information for the past 5 years:

Current Address:

Dates at Current Address:

Former Address:

Dates at Former Address:

Child 2:

Name:

Sex:

DOB:

Place of Birth:

Currently Resides With:

Please provide residence information for the past 5 years:

Current Address:

Dates at Current Address:

Former Address:

Dates at Former Address:

Child 3:

Name:

Sex:

DOB:

Place of Birth:

Currently Resides With:

Please provide residence information for the past 5 years:

Current Address:

Dates at Current Address:

Former Address:

Dates at Former Address:

If Married:

Date of Marriage:

Date of Separation:

Briefly describe the custody/visitation schedule for your children since separation:

Any additional information you feel is important for the attorney to know: