Divorce Client Intake Form

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Divorce Client Intake Form

{ATTORNEYS NAME}

{Date}

ALL INFORMATION GIVEN ON THIS FORM IS CONFIDENTIAL

0% Client Information

What is the purpose of your visit today?
Do you have a will?
Are you a U.S. Citizen?
If No, how long have you been in the USA? (Years, Months)
Do you need assistance with any immigration matter?
Do you need additional assistance with another legal matter?
What is your name? (Last Name, First Name, Middle Name)
What is your gender?
Are you a Junior or Senior with the same name as your father or son?
What is your Maiden name (if applicable)?
Have you ever used any other name(s)?
No,Yes (please list all other names used)
What is your date of birth?
Where were you born? (City, County, State, Country)
What is your address? (Street, Apt#, City, State, Country, Zip)
In what county do you live?
What is your home telephone number?
What is your work telephone number?
What is your mobile telephone number?
Do you authorize follow-up calls about your case?
If calls are authorized, what is the best phone number to use?
What is the best time to call?
What is your driver’s license or government- issued identification number?
What State issued your driver’s license or identification?
What is your Social Security Number?
Where do you work? (Employer’s Name)
What is the title of your job?
Do you work at home?
What is the address of your employer (if applicable)? (Street, Suite#, City, State, Country, Zip)
What is your annual salary?
How are you paid?
What is your email address?
Do you authorize emails about your case?

0% Spouse Information

Does your spouse have a will?
Is your spouse a U.S. Citizen?
If No, how long has your spouse been in the USA? (Years, Months)
What is your spouse’s name? (Last Name, First Name, Middle Name)
What is your spouse’s gender?
Is your spouse a Junior or Senior with the same name as their father or son?
What is your spouse’s Maiden name (if applicable)?
Has your spouse ever used any other name(s)?
What is your spouse’s date of birth?
Where is your spouse employed?
What is your spouse’s annual salary?
How is your spouse paid?
What is the telephone number of your spouse’s employer?
What is your spouse’s mobile telephone number?
What is your spouse’s home telephone number (if different from yours)?
What is your spouse’s email address?

0% Financially Responsible Person

Will another person be financially responsible for this legal case?
If Yes, what is the name of the financially responsible person? (Last Name, First Name, Middle Name)
What is their address? (Street, Apt#, City, State, Country, Zip)
What is their home telephone number?
What is their work telephone number?
What is their mobile telephone number?
What is their email address?
What is their driver’s license or government- issued identification number?
What State issued their driver’s license or identification?
What is their Social Security Number?
Will they sign a written agreement to be financially responsible for this case?

0% Emergency Contact Information

Who is the person we should contact in the case of an emergency?
What is their address?
What is their home telephone number?
What is their work telephone number?
What is their mobile telephone number?
What is their email address?

0% Referral Information

If an attorney or our employee referred you, please give their name.
How did you find out about us? (choose all that apply)
I am a previous client referred by a friend saw office while passing by saw billboard saw TV ad heard radio ad saw newspaper or magazine ad visited website found in phonebook attorney’s bar association letter from us another attorney one of our employees google search facebook or other social media

0% Family Legal History

Have you ever been involved in any other lawsuits?
Have you or a family member had any serious accidents in the last two years?
Have you ever been denied Social Security Benefits?
Have you ever been denied Veterans Benefits?
Did any of those accidents result in a lawsuit?

0% Family Information

What date was your marriage?
Where were you married? (City, State, Country)
Are you currently separated? (If Yes, please give the date of separation)
Do you have any children?
If Yes, how many children do you have in total?
How many children do you have from your current spouse?
For the children from your current spouse, how old were you at the time the oldest child was conceived?
How old was your spouse at the time the oldest child was conceived with you?
How many of your children from this current spouse live with you?
How many of your children from this current spouse live with your spouse?
Please list the children from your current spouse giving their full name, sex, social security number, date of birth and place of birth (City, County, State, Country)
Who provides health insurance coverage for the children?
What is the monthly cost for health insurance in total for all children conceived with your spouse?

0% Financial Information

Do you have a pre-nuptial agreement or any other agreement that divides the property between you and your spouse?
Are you currently in escrow to buy a house?
Do you own any homes with your spouse?
Do you own any stocks, bonds, or other investments with your spouse?
Do you own any life insurance with your spouse?
Do you or your spouse have any retirement benefits of any kind?
Do you and your spouse own any vehicles, including autos, trucks, and recreational vehicles like boats?
Have you ever filed bankruptcy?
Has your spouse ever filed bankruptcy while not married to you?

0% Divorce Case Information

Are you requesting a name change from the court as part of the divorce proceedings?
Have you ever been charged with a crime not including traffic citations?
Has your spouse ever been charged with a crime not including traffic citations?
Have you ever been convicted of a felony?
Has your spouse ever been convicted of a felony?
Adultery?
Child Abuse?
Computer Abuse?
Criminal Activity?
Excessive Alcohol Use?
Financial Problems?
Physical Violence?
Use of Illegal Drugs?
Sexual Abuse?
If physical violence is involved, has any Protective or Restraining Order been issued?
Have you ever had any other divorce proceedings or Family Law proceedings, such as a child custody case or an adoptions case in any court?
Are there any other important factors we should know about your case?

0% Have you personally ever had any of these issues:

Protective Order?
Restraining Order?
Child Protective Services Investigation?
Mental Health Professional Treatment?
Questionable Paternity Status?
Substance Abuse Treatment?
Welfare or Aid to Families with Dependent Children?
Common-Law or Informal Marriage?
Termination of Parental Rights?
Prenuptial Agreement or Partitioning Agreement?
Personal Injury Lawsuits?

0% Has your spouse ever had any of these issues?

Protective Order?
Restraining Order?
Child Protective Services Investigation?
Mental Health Professional Treatment?
Questionable Paternity Status?
Substance Abuse Treatment?
Welfare or Aid to Families with Dependent Children?
Common-Law or Informal Marriage?
Termination of Parental Rights?
Prenuptial Agreement or Partitioning Agreement?
Personal Injury Lawsuits?

0% FOR OFFICE USE ONLY

Divorce Status?
Child Custody?
Other?(give details)
Petition:
Answer:
Waiver:
Citation:
Temporary Restraining Order?
Protective Order?
Cross-Action:
Appearance:
Affidavit:
AG a party:
Insupportability:
Adultery?
Mental Cruelty?
Other?
Service?
Personal Service?
Time?
Alternate Service?
Uncontested Retainer: $
Court Costs: $
Total Uncontested Retainer: $
Down Payment $
Contested Retainer: $
Court Costs: $
Total Contested Retainer: $
Down Payment $
Payments: $
Qualified Domestic Relations Order: $
Order Number:
Deed: $
Deed Number:
COMMENTS?

Divorce Client Intake Form

Divorce Client Intake Form

{ATTORNEYS NAME} {Date} ALL INFORMATION GIVEN ON THIS FORM IS CONFIDENTIAL

0% Client Information

What is the purpose of your visit today?

Do you have a will?

Are you a U.S. Citizen?

If No, how long have you been in the USA? (Years, Months)

Do you need assistance with any immigration matter?

Do you need additional assistance with another legal matter?

What is your name? (Last Name, First Name, Middle Name)

What is your gender?

Are you a Junior or Senior with the same name as your father or son?

What is your Maiden name (if applicable)?

Have you ever used any other name(s)?

No,Yes (please list all other names used)

What is your date of birth?

Where were you born? (City, County, State, Country)

What is your address? (Street, Apt#, City, State, Country, Zip)

In what county do you live?

What is your home telephone number?

What is your work telephone number?

What is your mobile telephone number?

Do you authorize follow-up calls about your case?

If calls are authorized, what is the best phone number to use?

What is the best time to call?

What is your driver’s license or government- issued identification number?

What State issued your driver’s license or identification?

What is your Social Security Number?

Where do you work? (Employer’s Name)

What is the title of your job?

Do you work at home?

What is the address of your employer (if applicable)? (Street, Suite#, City, State, Country, Zip)

What is your annual salary?

How are you paid?

What is your email address?

Do you authorize emails about your case?

0% Spouse Information

Does your spouse have a will?

Is your spouse a U.S. Citizen?

If No, how long has your spouse been in the USA? (Years, Months)

What is your spouse’s name? (Last Name, First Name, Middle Name)

What is your spouse’s gender?

Is your spouse a Junior or Senior with the same name as their father or son?

What is your spouse’s Maiden name (if applicable)?

Has your spouse ever used any other name(s)?

What is your spouse’s date of birth?

Where is your spouse employed?

What is your spouse’s annual salary?

How is your spouse paid?

What is the telephone number of your spouse’s employer?

What is your spouse’s mobile telephone number?

What is your spouse’s home telephone number (if different from yours)?

What is your spouse’s email address?

0% Financially Responsible Person

Will another person be financially responsible for this legal case?

If Yes, what is the name of the financially responsible person? (Last Name, First Name, Middle Name)

What is their address? (Street, Apt#, City, State, Country, Zip)

What is their home telephone number?

What is their work telephone number?

What is their mobile telephone number?

What is their email address?

What is their driver’s license or government- issued identification number?

What State issued their driver’s license or identification?

What is their Social Security Number?

Will they sign a written agreement to be financially responsible for this case?

0% Emergency Contact Information

Who is the person we should contact in the case of an emergency?

What is their address?

What is their home telephone number?

What is their work telephone number?

What is their mobile telephone number?

What is their email address?

0% Referral Information

If an attorney or our employee referred you, please give their name.

How did you find out about us? (choose all that apply)

0% Family Legal History

Have you ever been involved in any other lawsuits?

Have you or a family member had any serious accidents in the last two years?

Have you ever been denied Social Security Benefits?

{ATTORNEYS NAME}

{Date}

ALL INFORMATION GIVEN ON THIS FORM IS CONFIDENTIAL