Client Information

Sex

Male

Female

Do you want to resume use of your maiden name (if applicable)?

Yes

Please specify your full name as you would like it to be following the divorce entry:

No

Not applicable

Client's current employer:

Length of employment with this employer:

Client Job Title:

Estimated Gross Annual Salary:

Have you or the opposing party every consulted or used another attorney for legal services? If so, which attorney?

How were you referred to us?

Is there current pending litigation in your case?

Yes

In which county? Please provide the case number:

No

Not pending, but there has been a case filed in the past (custody, etc.) involving the same opposing party/children.

In which county? What is the case number?

Opposing Party Information

Opposing Party's Current Employer

Opposing Party's Job Title

Opposing Party's Estimated Gross Annual Income

Full name of opposing party's spouse if married to someone else:

Case Information

Marital Status in relation to opposing party:

Never married

Married

Date of Marriage

Separated

Date of Marriage Date of Separation

Divorced

Is there any property that will need to be divided (i.e., homes/property, vehicles, bank accounts, retirement accounts, debts, life insurance, insurance policies, stocks, business ownership)? If so, please describe. Please note that even if the property or debt is only in one party's name, it may be subject to distribution, so please list everything that could be applicable.

Are there any issues related to alimony or spousal support?

Custody Information

Child #1 Full Name

Child #1 Date of Birth

Child #2 Full Name

Child #2 Date of Birth

Child #3 Full Name

Child #3 Date of Birth

Child #4 Full Name

Child #4 Date of Birth

Child #5 Full Name

Child #5 Date of Birth

Is there a current custody order or signed parenting/custody agreement in place?

yes

What date was the order entered/agreed to?

No

Are there any issues related to child support (current or retroactive)?

What is your goal for custody/visitation?

Are there any other facts/circumstances we should be aware of regarding custody, the parties, etc.?

Do you have any upcoming court dates with respect to any pending litigation that we need to be aware of?

Because we want our clients to understand fully the fees and costs paid for services rendered, we ask each client to read the following and acknowledge their understanding by checking the box below. The fee for the initial consultation is $125 for a 30 minute phone meeting. Any time over the thirty minutes is billed at the hourly rate of $250. Any time for other services is also rendered at the attorney's hourly rate of $250. Expenses such as filing fees, deposition costs, exhibit preparation/copying, service of process fees, etc. are billed separately and must be paid in advance.

I have read the fee policy above and by checking this box and submitting this form, I agree to be bound by the terms above. I understand that I am responsible for the above charges.