Please complete this form and then call my office for the consultation. Please read each question carefully.
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What is YOUR name and YOUR relationship to the child(ren) who are the subject of this consultation? *
Ex. Tom Smith, Father OR Jane Smith, Mother OR Pearl Smith, Grandmother, etc.
What is YOUR phone number and email address? *
Please specify if cell, home or work phone number and email
What is the child(ren)'s MOTHER'S AND FATHER'S FULL NAME? NOTE: these are the legal parents of the child(ren) who are the subject of this consultation. *
Ex. Jane Smith, Mother and Tom Smith, Father
Who is/are the child(ren) subject to THIS court case or potential court case?  First and Last name, and Age. *
ex. John Smith, 8
In which County do (does) the subject child(ren) live? (If not in NY, in which state do they live?) *
With whom does each of the children live? *
(Please list full name and relation. Ex. Tom Smith, Father OR Jane Smith, Mother OR Pearl Smith, Grandmother, etc.)
Names & ages of ALL OTHER children of BOTH parties - DO NOT INCLUDE THE CHILDREN ALREADY LISTED ABOVE. If there are no other children type "NONE" *
Include children of BOTH parties in this matter who are NOT the subject of this consultation/action. Ex. you have a child with another partner/spouse
Why are you seeking/what do you want to get out of this action? List any other relevant information you think I should know. *
Ex. More visitation, Change Custody from other party to you, etc.
Are there any PRIOR ORDERS for the children subject to THIS action (Ex. Judgment of Divorce, Custody Order OR Child Support Order)? *
IF YES, what kind? and briefly explain what the order says and which parts you would like changed?
If there are prior court orders regarding this matter please list everything that has changed since the last order was entered.
Ex. My daughter's father now works evenings and he has not been able to visit the times stated in the current order.
Status of the action: is there a court case pending? *
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