Matrimonial Matter Intake Sheet
Date of Consultation:
Reason for Consultation (Note: Custody/Visitation and Support Court are two different matters in Family Court, but one matter if in connection with divorce):
Has this matter been in court before?: ___yes ___no; If yes, what county and state?: ______
Your Information:The OTHER party’s information:
Name: Name:
First Middle LastFirst Middle Last
Mailing Address: Home Address:
Home Address, if different than mailing:
Occupation:
Employer:
Home Phone: Address:
Cell Phone:
Work Phone: Social Security #:
Occupation: Date of Birth:
Employer:Attorney:
Address: List any other names known by:
Social Security #:
List any other names you have had in the past:State of Birth:
Date of Marriage:
Date of Birth: City of Marriage:
State of Birth: County of Marriage:
Bank Name:State of Marriage:
Email:
Children:Birth DateCustody with: Social Security Number:
First Middle Last
First Middle Last
First Middle Last
Date Separated (physically or by written agreement):
Please Note (Cash or Personal Checks/Money Orders are acceptable):
The fee for a first consultation with the Attorney is $100 and is due today.
Any consultation after the first consultation is at the rate of $200 per hour and is due the day of the consult.
Please provide your consultation payment to Receptionist upon completion of this form.
Addresses that you or children have lived within the last five years: (If more than 2, write on back)
Dates of residence: Address:
Dates of residence: Address:
What county do the children currently reside?:
Who has physical residence with the children?:
Medical Insurance Provider: ___ self ___other party Type of coverage (medical, dental, etc.)
Insurance ID #: Provided by employer or other entity?
If there are other parties involved with this matter, please list below: (Example: Other parties listed on Petition, Child Protective, Police Agencies, Department of Social Services, Support Collection Unit, etc. )
Do you have other matters pending in any other Courts?:
Have I represented in the past?: ___ yes ___ no: if so, for what type of matter?
Confidential Information which must be supplied to complete any divorce matter:
Your Information:Other Party’s Information:
Race: Race:
Education (Grade or number of college years): Education (Grade or number of college years):
Prior Marriages & How Ended: Prior Marriages & How Ended:
#___ by death; # ___by divorce#___ by death; # ___by divorce
Wife’s Maiden Name: Number of children born alive of this marriage: ______
Number of children under the age of 18: ______
How were you referred to my office?:
**If you will be asking the attorney to represent you, please note the following:
**If you will be retaining the attorney to represent you, you will need to review and sign a Statement of Clients’ Rights and a Retainer Agreement. The attorney has not been hired to represent you until both the Statement of Clients’ Rights and Retainer Agreement are signed and the retainer fee is paid.
Should you have questions regarding any of the above,
please ask the attorney during your consultation. Thank you