NEW FAMILY LAW CLIENT INTAKE FORM Please complete the following intake form. A team member will contact you as soon as possible. We look forward to working with you. If you are human, leave this field blank.Page 1 of 6First Name: *Last Name: *Street Address: *Apt #:City: *Select a State: *North CarolinaSouth CarolinaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip: *Home Phone: *Mobile Phone:Work Phone:Email Address: *Confirm Email Address: *Date of Birth: (mm/dd/yyyy)Can we send you mail? *YesNoCan we call you? *YesNoPage 2 of 6Opposing PartyFirst Name:Last Name:Street Address:Apt #:City:Select State:North CarolinaSouth CarolinaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCounty:Zip:Home Phone:Mobile Phone:Work Phone:Email Address for Party:Confirm Email Address for Party:Page 3 of 6Minor Child(ren)Name - Child #1:Date of Birth: (mm/dd/yyyy)Age:GenderMaleFemaleSchool Attended:Name - Child #2:Date of Birth: (mm/dd/yyyy)Age:GenderMaleFemaleSchool Attended:Name - Child #3:Date of Birth: (mm/dd/yyyy)Age:GenderMaleFemaleSchool Attended:Name - Child #4:Date of Birth: (mm/dd/yyyy)Age:GenderMaleFemaleSchool Attended:Are there children from other relationships?YesNoPage 4 of 6Opposing Counsel:Opposing Attorney:Law Firm:Email:Confirm Email:Address:City:Select a State:North CarolinaSouth CarolinaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip:Brief Description of CasePage 5 of 6Notice:In order for your attorney to address any financial issues with you during your consultation which include but are not limited to Alimony, Post Separation Support, Equitable Distribution and/or Child Support, please fill out the following section to the best of your knowledge.Page 6 of 6Additional InformationYour Occupation:Your Employer:Your Gross Income:Opposing Party's Occupation:Opposing Party's Employer:Opposing Party's Gross Income:Date of Marriage: (mm/dd/yyyy)Location of Marriage:Date of Separation: (mm/dd/yyyy)Date of Divorce: (mm/dd/yyyy)Contract(s)/Court Orders:Will:SUBMIT
