FAMILY LAW PROSPECTIVE CLIENT INFORMATION
CONFIDENTIAL CLIENT INTAKE SHEET
Date:
* Skip any section with an asterisk if there are no children from this marriage.
I. GENERAL INFORMATION:
Name (required):
Address (required):
City:
State:
Zip:
Fax:
Phone (required):
E-mail Address (required):
Employer Name:
Address:
Emergency Contact:
Relationship:
How did you hear about our firm?
What is your primary objective in coming to our firm?
You are the (select one): PetitionerCo-PetitionerRespondent
Case Number, if any, assigned by Court (example, “02DR152”):
County in which matter is pending (example, “Denver”):
It is anticipated this matter will be (select one): ContestedNot ContestedBy Default
How Many Children?
II. PERSONAL DATA:
Date of Birth:
Gross Monthly Income:
In Active Duty Military? NoYes
Social Security No:
Colorado Resident since:
Drivers License No:
III. OPPOSING PARTY: ( spouse, former spouse, or co-parent)
Name:
MaleFemale
In Active Duty Military? YesNo
Employer Address:
Represented by Attorney? YesNo
(Attorney Name):
(Atty Address):
IV. OTHER POTENTIALLY INTERESTED PARTIES:(Grandparents, etc.)
Describe the Nature of Relationship:
V. CHILDREN AT ISSUE*
First Child Information:
Resides with (name):
Second Child Information:
Third Child Information:
*If additional space is required, use the back of this form
VII. MARRIAGE FACTS: (complete regarding your present marriage)
This is a Petition for (select one): Dissolution of MarriageLegal Separation
Is the Wife pregnant? YesNo
Date of Marriage:
Place of Marriage:
Date of Separation:
