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    Family Intake Questionnaire.p01

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    krysba889046

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    © All Rights Reserved
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    Family Intake Questionnaire.p01

    Uploaded by

    krysba889046
    1 views1 page

    Copyright

    © © All Rights Reserved

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    Copyright:

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    1 views1 page

    Family Intake Questionnaire.p01

    Uploaded by

    krysba889046

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    FAMILY LAW QUESTIONNAIRE H R P

    Name: _____________________________ Engagement Fee _________________


    Address: _____________________________ Hourly Rate _________________
    City: _____________________________ Cost Deposit _________________
    County: _____________________________ DOM PAT DCF CS SUPP CUST OTH

    Cell Phone: _____________________________ Social Security No. ____ - ____ - ____


    Work Phone: _____________________________ Driver’s License No. _______________
    Home Phone: _____________________________ D.O.B. ____ / ____ / ______
    Email Address: ____________________________
    Present Employer: _________________________ How long? _______________________
    Salary: $ __________________ weekly___/biweekly___/monthly___/annual___ (check one)
    Are you or your spouse currently pregnant? ______
    How did you hear about our office? ______________________________________________
    Have you retained any other attorney on this matter prior to coming to our office?
    (if yes, please provide name, date retained, and reason to discontinue representation)
    ___________________________________________________________________________
    Have you ever been arrested? ____ If so, when and what for? _________________________
    Have you ever been involved in a DCF case? _____
    SPOUSE/BOYFRIEND/GIRLFRIEND/OTHER PARTY INFORMATION:
    Name: _______________________ Soc. Sec. No.: ____-___-____ D.O.B. ___/___/______
    Home Address: ______________________________________________________________
    City: _____________________________ State: _______________ Zip Code: ___________
    Are they represented by counsel? ____ If so, name of attorney: _______________________
    Employer’s Name (if any): _____________________________________________________
    Date of employment: _________________ Occupation: _____________________________
    Salary: $ __________________ weekly___/biweekly___/monthly___/annual___ (check one)
    Have they ever been arrested? ____ If so, when and what for? _________________________
    Have they ever been involved in a DCF case? _____
    CHILDREN’S INFORMATION (from this relationship):
    Name Soc. Sec. No. Place of Birth D.O.B. Living with: Sex:
    M__/__F
    M__/__F
    M__/__F
    M__/__F
    ASSETS OF VALUE (if dissolution of marriage) DEBTS (if dissolution of marriage)
    Home: Mortgage:
    Other real property: Mortgage:
    Vehicle: Car Loan:
    Vehicle: Car Loan:
    RV: Credit Card:
    Boats: Credit Card:
    Motorcycle/ATV: Credit Card:
    Retirement account: Other:
    Retirement account: Other:
    Other asset: Other:
    OTHER ISSUES: Dissipation/wasting of marital assets? ____ Gambling? ____
    Pornography? ____ Alcohol/drugs? ____ Other:__________________
    GLP Family v.02-24

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