Divorce/Legal Separation Client Intake Form

Please complete the following form prior to your initial consultation.

First Name *

Middle Name *If you do not have a middle name, please answer “N/A”

Last Name *

Your Date of Birth *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Spouse's Full Name (First, Middle/Maiden, Last) *

Spouse's Date of Birth *

YOUR SPOUSE'S street address *

City *

State/Province *

Country

Date of Marriage *

If you were married in a court and then had a ceremonial wedding on a different day, or if you had two/multiple wedding ceremonies, please give the date on which you obtained your marriage license or were first legally married to your spouse.

Are you and your spouse still living together? *Please select yes or no.

When did you and your spouse start living in separate homes? *

Who is still living in the marital/family home? *

Are you employed (including self-employed)? *Employed in any capacity: full-time, part-time, contract, temporary/seasonal, independent consulting, self-employment, etc.

Employer

Employment PositionIf you have more than one employment position, please include that in the additional comments section at the end of this form.

Rate of Pay *

Your last employment position: *

Your last employer: *

Approximate date on which you were last employed: *

Amount you earned (gross) last year: *

Amount you expect to earn (gross) this year: *

Is your spouse currently employed? (Including self-employed) *

Spouse's Employer *

Spouse's Employment Position *

Spouse's Annual Income last year (gross, approximate) *Please enter your spouse’s gross income for last year. Approximate earnings is fine.

Spouse's Annual Income this year (gross, approximate) *

Do you and your spouse have children? *If you have minor step-children or minor children from another marriage, please note that in the additional comments at the end of this form.

List your children's full names (first, middle, last) and birthdates (mm/dd/yyyy) *

Who are your children living with? *

Assets *

Have any pleadings or documents been filed in your case? *Have any documents been submitted to the court in your case? For example, has a Petition for Divorce and Summons been filed? Or, have you been served with any paperwork?

Upload Pleadings/Documents

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Upload any pleadings or documents that have been filed or any documents that you have been served with.

Is Domestic Violence an issue in this case? *Please answer yes if domestic violence has occurred or if your spouse has accused you of domestic violence.

Explain: *

Has a Petition for Domestic Violence Protection Order been filed (by you or by the other party) or has a DVPO or other protection/restraining order been entered by the court? *Has a Petition for Domestic Violence Protection Order been filed (by you or by the other party) or has a DVPO or other protection/restraining order been entered by the court?

Upload the DVPO Petition and/or DVPO Order

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Additional Comments