Client Intake Form

Thank you for choosing our firm for consultation. Before completing the form, please visit our resources page and blog for additional family law information. If we decide to accept your case, we will prepare a written employment agreement that establishes the scope and terms of our representation.

We hope what you learn in consultation with us will be valuable to you. We encourage you to complete the client information form in advance of consultation so that we have all of your information before we meet. Please be aware, however, that submitting the information form alone does not establish an attorney/client relationship and does not require us to take any action. The attorney/client relationship is only formed after you have engaged the firm and consulted personally with one of our attorneys.

Your consultation with us is confidential and will preclude us from representing the opposing party. We discourage the attendance of friends and family at your initial consultation with us in order to preserve attorney/client privilege and to avoid distraction.

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Client Information

Full Name

First Name

Last Name

Email Address

Secure Postal Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

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Work Phone

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Cell Phone

(###)

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Date of Birth

Employer

Gross Monthly Income

Opposing Party (OP) Information

OP Name

First Name

Last Name

OP Email Address

OP Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

OP Home Phone

(###)

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OP Work Phone

(###)

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OP Cell Phone

(###)

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OP's Employer

OP's Gross Monthly Income

OP's Attorney

OP's Date of Birth

Marriage and Separation Information (if applicable)

Date of Marriage

County and State of Marriage

Date of Separation

Date of Divorce

Is there a pre or post-marital agreement?

Yes

Child Custody and Support Questions (if applicable)

Child Name (#1)

Date of Birth (#1)

Child Name (#2)

Date of Birth (#2)

Child Name (#3)

Date of Birth (#3)

Child Name (#4)

Date of Birth (#4)

How are you and the other parent sharing custody?

What work related child care costs are incurred by you or the other parent?

Do the children have health/vision/dental insurance coverage?

If yes, who pays and what is the children's premium?

Has there been previous litigation concerning child custody and support? If yes, please describe to the best of your ability.

Residential address of child/ren for the last 5 years

Case Summary

Additional notes/questions

Please tell us who referred you or how you learned about our services.

Client Disclosure Agreement

NOTE: Before clicking send, for your records you may want to print your completed client consultation form from a secure and private printer by navigating to the top of the page and clicking on the printer icon.

I have read the client disclosure at the top of the form and understand/agree to the conditions.

How did you hear about us?

TESTIMONIAL

Jim Siemens is a genuinely nice guy. In the courtroom and in legal actions, Jim has used his extensive knowledge of the law, amazing intelligence, and quick thinking to do a great job. At last I feel like someone is on my side and my case is moving along. Finally, I have hope.

—Barbara