General Intake Form – All Matters
Thank you for contacting our law office. Please read the privacy notice below and complete this intake form in full before your consultation.
Privacy Notice
All information received from a prospective client or client is treated as confidential and handled in accordance with applicable law and firm policy. Information submitted through this form should be transmitted and stored using secure, encrypted systems.
Social Security numbers and other sensitive personal information should be collected only when reasonably necessary for identification, court filing, conflict checks, or representation-related purposes. In Ohio domestic relations matters, certain personal identifiers may be required in filings or confidential disclosure forms under the Ohio court rules governing personal identifiers
and confidential information in filings. If you have questions about how your information will be used, please contact the law office before submitting this form.
Contact Information: Prospective Client
Contact information
Prefix
First name
*
Middle name
Last name
*
Date of birth
Emails
Email Address
*
Type
Upon submission, a copy of this form will be sent to the primary email.
Work
Home
Other
Primary
Default email false
Add email
Addresses
Street address
Country
Australia
Canada
United Kingdom
United States
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Primary
Default address false
Add address
Phone numbers
Phone number
Type
Work
Home
Mobile
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Other
Primary
Default number false
Add phone number
Contact Information: Opposing Party
Prefix
First Name
Middle Name
Last Name
Date of Birth
Email Address
Email Type
Email Type
Additional Email
Street Address
Country
City
State/Region
Zip/Postal Code
Address Type
Primary Address
Additional Address
Phone Number
Phone Type
Phone Type
Additional Phone Number
Additional Opposing Party?
Provide Details
Prefix
First Name
Middle Name
Last Name
Date of Birth
Email Address
Email Type
Primary Email
Additional Email
Street Address
Country
City
State/Region
Zip/Postal Code
Address Type
Primary Address
Additional Address
Phone Number
Phone Type
Primary Phone
Additional Phone Number
Not Applicable
Additional Opposing Party?
Provide Details
Prefix
First Name
Middle Name
Last Name
Date of Birth
Email Address
Email Type
Primary Email
Additional Email
Street Address
Country
City
State/Region
Zip/Postal Code
Address Type
Primary Address
Additional Address
Phone Number
Phone Type
Primary Phone
Additional Phone Number
Not Applicable
Additional Opposing Party?
Provide Details
Prefix
First Name
Middle Name
Last Name
Date of Birth
Email Address
Email Type
Primary Email
Additional Email
Street Address
Country
City
State/Region
Zip/Postal Code
Address Type
Primary Address
Additional Address
Phone Number
Phone Type
Primary Phone
Additional Phone Number
Not Applicable
Matter Screening Questions
Are you or have you been married to the opposing party?
Yes
Date of Marriage?
Place of Marriage (City (or county), State)?
Date of Separation, if applicable?
Prenuptial/postnuptial agreement?
No
Are there minor children at issue in your case?
Yes
Child name
Date of Birth
Current Living Arrangement
School District
Current parenting time exercised?
Please provide the same information for any additional children:
No
Do you or the opposing party have any other minor children?
Yes
Child name
Date of birth
Is there a support order with regard to this child?
What is you custody arrangement for this child?
Please provide the above information for any additional children
No
What legal issue are you seeking a consultation about?
Divorce
Dissolution
Child Custody
Child Support
Spousal Support
Modification of a prior decree
Modification of a prior decree
Emergency Custody
Non-parent Custody
Establishment of a Parenting Plan
Defense of a CPS case
Adoption
Name Change
Guardianship
Prenuptial or postnuptial agreement
Other
If other, please describe:
Are you currently employed?
Yes
Name of employer
Job Title
Salary (annualized)
Hourly Rate, if applicable
Typical number of hours worked
Typical schedule
No
Is opposing party employed?
Yes
Name of employer
Job Title
Salary (annualized)
Hourly Rate, if applicable
Typical number of hours worked
Typical schedule
No
To your knowledge, is there any currently pending litigation or active court case?
Yes
Case Number
Court Name
County
State
Next Hearing Date
No
To your knowledge, has there been any prior litigation or court involvement?
Yes
Case Number
Court Name
County
State
Next Hearing Date
Type of case (divorce, custody, etc.)
Result of the case
No
Do you have any immediate safety concerns for yourself or any child?
Yes
Brief description of concern:=
Protective orders in place?
Recent incidents
Injuries?
Weapons access?
Weapons access?
Whether emergency services have been contacted?
If yes, which services
No
Do you have concerns that the opposing party is using or abusing substances or exhibiting unaddressed mental health symptoms?
Yes
Nature of the concern
Dates or approximate timeframes
Specific behaviors observed
Specific behaviors observed
Whether medical, police, school, or third-party records may exist.
Whether medical, police, school, or third-party records may exist.
No
Conclusion
Is there anything else the attorney should know before the consultation?
How did you hear about us?
Certification
The prospective client confirms that the information provided is true and complete to the best of their knowledge and that they have read and acknowledged the firm's privacy notice.
Yes
THANK YOU
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