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Conrad & Associates APC
Client Intake Form
This form is confidential. It takes a little time, but it's worth it and it will save you money.
It is important to complete these questions as fully and accurately as possible. After the initial consultation, you will be paying for the time we spend on your case and you will save expenses by providing us with complete information.
This form is designed to alert us to items to which we should give attention, as well as to provide necessary information. We do not know the facts of your case as well as you do. Tell us as much as you know so that we can do the best job for you. The information you provide will be kept confidential and shall NEVER be shared with anyone.
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Email
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Your email
Please provide us any general or background information about you and the other party. You'll have a chance to go further into this when you meet with your attorney.
What is your full legal name?
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Your answer
What is your current address?
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Your answer
How long have you lived in Orange County, California?
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Your answer
If you need to receive mail from this office and want it sent to a different address, please furnish the desired mailing address here:
Your answer
What is your current telephone number?
*
Your answer
Your date of birth?
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DD
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YYYY
Your drivers's license number and state of issue?
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Your answer
Please provide the last four digit of your Social Security Number.
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Your answer
Your current age?
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Your answer
Are you currently employed?
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Yes
No
Required
If yes, please provide the name of your current employer.
Your answer
What is your job title?
Your answer
What is your monthly gross income?
Your answer
What is the full legal name of your spouse, registered domestic partner, the other parent, or other party?
*
(Please include any maiden name in parenthesis)
Your answer
Other party's date of birth?
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MM
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DD
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What is your spouse, registered domestic partner, or the other parent's address?
(We will NOT be contacting them unless you retain our services)
Your answer
What is the other party's telephone number?
(We will NOT be calling unless you retain our services)
Your answer
How long has the other party resided in Orange County, California?
Your answer
Other party's driver's license number and state of issue?
(If known)
Your answer
The other party's Social Security Number?
(If known)
Your answer
The other party's place of birth?
Your answer
The other party's current age?
Your answer
Is the other party employed?
Yes
No
If yes, please provide the name of the employer.
Your answer
What is the other party's job title?
Your answer
What is the other party's monthly gross income?
(Estimate if not known)
Your answer
Marriage, Registered Domestic Partner and Family Information
What was the date of your marriage or registered domestic partnership?
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MM
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DD
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YYYY
Place of marriage?
Your answer
Do you have a prenuptial or premarital agreement with your spouse or registered domestic partner?
Yes
No
Clear selection
Are you presently living together with your spouse, registered domestic partner, or the other parent?
Yes
No
Clear selection
If no, on what date did you separate?
MM
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DD
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I have NEVER been married to, or have NEVER entered into a Registered Domestic Partnership with my child(ren)’s other parent.
(True or false)
Yes
No
I am visiting the Law Office because:
(Choose any/all that apply)
Choose
I have been served papers by my spouse, registered domestic partner, or the other parent.
I want to file for Divorce or termination of Domestic Partnership.
I am considering Divorce or termination of Domestic Partnership.
I want information about a Legal Separation.
I want to establish Paternity of a child.
I want to change a prior Court Order.
I want to enforce a prior Court Order.
If you have prior Court Orders, please select any that apply:
Choose
Child support
Child custody and visitation
Sousal Support
Division of property
Do you have any minor children?
Yes
No
Clear selection
If yes, please give full name, age, date of birth and sex of each minor child, and indicate whether the child was born of this marriage or of a former marriage of your spouse, registered domestic partner, the other parent, or yourself.
Your answer
Are you or your spouse currently pregnant?
Yes
No
Clear selection
Divorce or Legal Separation
If you are already divorced or legally separated, please tell us the date of the divorce decree.
MM
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DD
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YYYY
Where did your divorce or legal separation occur?
(City, County or State)
Your answer
Have any orders been issued by a court modifying the original decree?
Yes
No
Clear selection
If yes, did you or will you bring copies of those orders to your consultation?
Yes
No
Clear selection
Child Custody and Visitation
Who currently has physical custody of the minor child(ren)?
You
Spouse or Registered Domestic Partner
Other parent
Both
Clear selection
Is the present custody arrangement by:
Private agreement
Court Order
Other
Clear selection
Are you current seeking custody of a minor child(ren)?
Yes
No
Clear selection
Are there currently any restraining orders or any other type of custody order in effect or pending before the court?
Yes
No
Clear selection
Please bring a copy of any current or pending court orders with me to my consultation.
Yes I will.
No I won't.
Clear selection
Child Support
Are you currently paying child support?
Yes
No
Clear selection
If yes, how much per month?
Your answer
Are you currently receiving child support?
Yes
No
Clear selection
If yes, how much per month?
Your answer
Are you currently seeking child support?
Yes
No
Clear selection
Has any court ordered child support in your case?
Yes
No
Clear selection
Is the Department of Child Support Services (DCSS) involved in your case?
Yes
No
Clear selection
Do you need to make changes to your current support orders?
Yes
No
Clear selection
Is there anything we should know about the mental or physical health of any party to this matter?
Your answer
Do you have any children with special needs?
Yes
No
Clear selection
Spousal Support
Do you need to establish/modify a current spousal support order?
Establish
Modify
Clear selection
If you wish to modify, how much spousal support is currently payable each month?
Your answer
Are you paying spousal support or receiving it?
I pay it
I receive it
Clear selection
There are emergency orders involved in my case or I may need them. I fear for my safety (and that of my children) because he/she has:
Actually hit me or threatened to cause me physical harm.
Actually hit the CHILD(REN) or threatened to cause the child(ren) physical harm.
Threatened me or a member of my family with a weapon.
I believe my Spouse, registered domestic partner, or the other parent will continue the abuse and/or carry out the threats against me and/or my child(ren).
My spouse, registered domestic partner, or the other parent has a substance abuse problem.
My spouse, registered domestic partner, or the other parent has either threatened to take the child(ren) away or has actually taken our child(ren) away.
Law enforcement has been called to my home.
There is already a restraining order in my case.
Clear selection
I have a current restraining order against me.
Yes
No
Clear selection
Additional Information
You are almost done!!
Are you or your Spouse, registered domestic partner, or the other parent currently in the U. S. Armed Forces?
Yes
No
Clear selection
Does your Spouse, registered domestic partner, or the other parent have an attorney?
Yes
No
Clear selection
If yes, what is the name of your spouse's attorney?
Your answer
Do you or your Spouse, registered domestic partner, or the other parent ever carry concealed weapons?
Yes
No
Clear selection
Have you or your spouse, registered domestic partner, or the other parent consulted us for legal advice before?
Yes
No
Clear selection
Please give us a physical description of your spouse or registered domestic partner and the vehicle they drive, if you know it.
Your answer
If we needed to serve your spouse or registered domestic partner legal papers, what address would be best? What time of day would be best?
Your answer
Please give us the name and telephone number of any individual to contact in case we are unable to reach you.
Your answer
How Did You Hear About Our Firm?
This information has nothing to do with your case, but we appreciate you taking the time to tell us!
I was referred to your office by:
Your answer
I searched the internet and found you on:
*
Google
Avvo
Yahoo
Yelp
I don't remember
Other:
This is the search term I used online:
Sample: Family Lawyer Laguna Hills
Your answer
Regarding fees for my initial consultation. I understand that as a courtesy, the first thirty (30) minutes of this initial consultation are being offered without charge to me. I further understand and agree that after the initial 30 minutes, I shall be responsible to pay the attorney’s hourly consultation fee rate, prorated at the rate of $300.00/hr.
I understand and agree to the above statement.
I do not understand and wish to discuss the initial consultation with someone at Geller Conrad Duvel LLP.
Clear selection
Today's current date and time is:
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MM
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Time
:
AM
PM
I understand that Conrad & Associates APC has not accepted my representation and will not act as my attorney until I have signed a fee agreement and paid any necessary retainer or other fees.
I understand and agree.
(Please enter your initials below)
Your answer
A copy of your responses will be emailed to the address you provided.
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