Intake Form

Confidential Intake Form

Please complete the following, confidential intake forms before your scheduled appointment. Please feel out in as much detail as possible. This form should take approximately fifteen (15) minutes to complete.

Name *

Phone *

Email Address *

Address *






Date and Time of Consultation with Work Law *

If you have scheduled a consult with Work Law, please provide the date and time of your consult. If you have yet to schedule a consult, please provide an available date and time.

Employer *

Name | Title | Income

Name of Opposing Party/Spouse

Opposing Party/Spouse's Employer and Income

Existing Case

Are you looking for representation in an existing case?

YesNo

Case Number

If there is an existing case, please provide the case number:

Detailed summary of legal matter

Legal issues *

Please check each legal issue that applies to your case.

Children's Name(s) and Date(s) of Birth

If applicable, please provide children's names and dates of birth.

Physical Custody Sought (if applicable) *

If applicable please indicate the physical custody sought.

Primary PhysicalJoint PhysicalNot Applicable

Custody

If requested, please specifically indicate why the court should grant you primary physical custody of your child.

Example: Education Benefits, Siblings, Safety, Mental and Physical Health, Routine, School, Activities.

Detail is critical.

If this does not apply, please indicate below.

Next Court Date and Time *

Please include date, time and location. If there is no scheduled court date please indicate below.

Debts and Assets *

If applicable, please provide a list of debts and assets and how you wish the court to divide.

Length of Marriage

If applicable

How did you hear about us? *

GoogleYelpFacebookAttorney ReferralPersonal ReferralAvvoOther

By checking this box, I consent to the consultation fee due on date of consult.

ConsentReschedule Consultation

Please Initial to Approve Confidential Attorney Review


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