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Divorce Intake Form

NOTE: An asterisk (*) indicates REQUIRED information. The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

*Name:   
*Street Address:   
*City:   
*State:   
*Zip:   
*Main Contact Phone Number:   
Cell:   
Home:   
Work:   
*Email Address:   
 
*HOW DID YOU HEAR ABOUT US?
AT&T BellSouth Yellow Pages Phone Book
Yellowpages.com
Referral
FindLaw.com
Attorney Search Network
Google search
Yahoo search
Other:
If you selected other, please indicate the source:   
 
*Are you employed?:    Yes   No
Occupation:   
Current Salary:   
 
*Is your spouse employed?:    Yes   No
Spouse's Occupation:   
Spouse's Current Salary:   
 
*Do you live in Georgia?:    Yes   No
If you currently live in Georgia, what county?:   
 
If you currently live outside of Georgia, have you ever lived in Georgia?:    Yes   No
 
If you have ever lived in Georgia, When?:   
 
*Are you currently separated from your spouse?:    Yes   No
If you are currently separated from your spouse, please list your spouse's address:

County:   
 
*If you are not separated from your spouse, Are you living in a state of bona fide separation (separate rooms)?:    Yes   No
 
*Are there minor children born during the marriage?:    Yes   No
If there are minor children, How Many?:   
What are their ages?:   
 
Do the parties have an agreement as to who will have custody?:    Yes   No
 
Do the parties have an agreement in place as to child support?:    Yes   No
 
*Do the parties own real (land) or personal property (all other property) that was purchased during the marriage?:    Yes   No   Don't Know
 
If Yes, Do the parties have an agreement as to how property will be divided or is there a dispute?:    Yes   No
 
*Are there any issues of domestic violence or any issues that make this an emergency?:    Yes   No   Don't Know
 
*Do the parties get along?:    Yes   No   Don't Know
 
*What is the reason for wanting divorce?:   
 
*Do you think your spouse will consent to service of papers?:    Yes   No   Don't Know
 

Please Note: The firm provides up to 15 minutes free phone consultation with prospective new clients to see if you are in need of legal representation and to assist in understanding the process required to address your specific legal concern. After the 15 minute consultation, an Attorney will provide you with the option of proceeding to a full consultation at a fee of $250 for a full hour of consultation. That consultation fee will be waived IF YOU RETAIN US ON THE DAY OF THE INITIAL CONSULT. You will then be asked to complete a full client questionnaire in advance of your next consultation. You will also be requested to bring certain financial documents with you to determine child support if applicable.