Intake Questionnaire

Confidential Divorce Intake

Please complete this questionnaire as thoroughly as possible. The information you provide helps our team better understand your situation before your consultation.

Before you begin: This form may take 15–25 minutes to complete. If a question does not apply, you may leave it blank unless marked required.

INTAKE QUESTIONNAIRE – DIVORCE

"*" indicates required fields

Personal & Demographic Information

Client

(Please Use Full Name & Middle Initial)

Name*

SSN*

Physical Address*

Street Address City State ZIP Code

Mailing Address (if different from physical)

Street Address City State ZIP Code

(if different from physical address) What County Do You Reside In?

Date of Birth*

Age*

Birthplace*

Home Telephone

Work Telephone

Ext.

Cell Telephone

Email*

Please indicate the best place to contact you:*

Home

Work

Cell

Are you a U.S. Citizen?*

If not, what is your immigration status:

Other Party

(Please Use Full Name & Middle Initial)

Name*

SSN*

Physical Address*

Street Address City State ZIP Code

Mailing Address (if different from physical)

Street Address City State ZIP Code

In what county do other party reside?*

Date of Birth*

Age*

Birthplace*

Home Telephone

Work Telephone

Ext.

Cell Telephone

Email*

Please indicate the best place to contact you:*

Home

Work

Cell

Is the other party a U.S. Citizen?*

If not, what is that person's immigration status:

Marital Status

Wife's Maiden Name*

Date Married/Registered Domestic Partnership*

Where Married/Registered Domestic Partnership (City & State)*

Date Separated, if applicable

Residency*

Date you first resided in California (continuously)*

County (continuously)*

Date spouse first resided in California (continuously)*

County (continuously)*

Children

Name

Age

DOB

Place of Birth

Please specify if any children are from a previous relationship:

Please specify if any children from this relationship have Native American Heritage

If you and your spouse already separated, what is the current custodial arrangement (by Court order of informal agreement)? Please describe.

*please provide copies of all relevant pleadings and/or any court orders prior to your consultation*

PENDING LITIGATION

Has a case been filed?*

If YES, please provide the following:

Date of Filing

County

Petitioner

Name of Petitioner's Attorney

Respondent

Name of Respondent's Attorney

Case Number/Docket Number:

Are there any temporary orders in place?

If YES, please describe the orders below:

Any upcoming court dates?

*Please provide copies of all relevant pleadings and/or any court orders prior to your consultation*

Employment Information

Your Employment Information

Current Employer*

Gross Annual Income:*

Start Date with Current Employer*

Other forms of compensation (average annual amount)

Bonus

Restricted Stock Units (RSU)

Options

If employed by other companies/employers between Date of Marriage and Current Employer, please provide the following information

Name of Company/Employer

Start Date

End Date

If NOT currently employed outside the home, please indicate reasons and commencement (e.g. disabled, stay-at-home parent, other)

Other Party/Spouse's Employment Information

Current Employer

Gross Annual Income

Start Date with Current Employer

Other forms of compensation (average annual amount)

Bonus

Restricted Stock Units (RSU)

Options

If employed by other companies/employers between Date of Marriage and Current Employer, please provide the following information

Name of Company/Employer

Start Date

End Date

If NOT currently employed outside the home, please indicate reasons and commencement (e.g. disabled, stay-at-home parent, other)

ASSET INFORMATION

Primary Home

Do you and/or your spouse own your home?*

Yes

Approximate Date of Purchase

Name(s) on deed

Estimated value ($)

Estimated outstanding mortgage ($)

Name(s) on mortgage

Other Real Estate

Do you and/or your spouse own any real estate (e.g. second home, time share, unimproved land, etc.)?

Other Properties

Approximate date of purchase

Name(s) on deed

Estimated value ($)

Estimated outstanding mortgage ($)

Name(s) on mortgage

If you have more than 3 properties, please provide additional information below

Retirement Accounts

Do you and/or your spouse have retirement plans created during marriage (e.g. IRA, 401(k), Pensions, etc.)?

If YES, please provide the following information:

YOU

Type of Plan

Dates of Participation

Approximate Value ($)

SPOUSE/OTHER PARTY

Type of Plan

Dates of Participation

Approximate Value ($)

Other Accounts

Do you and/or your spouse have other assets?