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Family Divorce Intake Form

*Name:
*Address:
*City:
*State:
*Zip:
*E-mail address:
*Home Phone:
Business Phone:
Cellular or Pager:
Facsimile:
What type of family law matter are you interested in?
Are you currently married or cohabiting?
Yes     No
Check one:
Married  Cohabiting 
If yes, list his or her name, date of birth, and date of marriage/cohabitation:
Do you have children?
Yes  No 
If yes, list their names and dates of birth:
Name Date of Birth
If you have children, with whom and where do they live now?
Were you previously married?
Yes  No 
If yes, when and how did your previous marriage(s) end?
Is your case contested or do you anticipate you will meet opposition to your anticipated actions?
Yes  No 
Have you been served with papers in a family law matter?
Yes  No 
If yes, what is the name of the opposing party and his or her attorney (if known)?
What is your relationship with the opposing party?
If "Other Relationship," please explain:
Have you appeared in court or agreed on terms related to this matter?
Yes  No 
Do you have copies of any documents (court decrees, dissolution agreements, etc.) related to this matter?
Yes  No 
What types of documents do you have?
Is domestic violence an issue in this matter?
Yes  No 
If yes, please describe, including any court actions and incident dates.
Is property at issue?
Yes  No 
If yes, please describe the property and anything known with regard to legal ownership.
Are you or any person involved in this matter currently pregnant?
Yes  No 
Where did you hear about this website?


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Haines & Krieger, L.L.C. 1020 Garces Ave., Suite 100, Las Vegas, Nevada 89101 | phone: 702-880-5554, fax: 702-385-5518
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