The following questionnaire is designed to help you more accurately provide information that will help us prepare court pleadings on your behalf. Please complete this form as fully and comprehensively as possible. If exact information is not known, please provide your best estimate. You may be asked at some future date to provide more precise information.

Confidential information provided on this form is protected by the attorney-client privilege and is intended for the use of your legal counsel. Any information provided in this form which is detrimental to you will not be revealed by counsel without your consent unless it is in your best interests to do so except in certain narrow and limited situations required or authorized by law. If you have any questions about the confidentiality of this information we will be pleased to answer them. Because this information is provided in confidence, we ask that your answers be as truthful, complete and accurate as possible. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

Contact Information: About You

First Name

Last Name

Date of birth

Company

Emails

Email Address *

Upon submission, a copy of this form will be sent to this email.

Address

Street Address

Country

City

State/Region

Zip/Postal Code

Address Type

Phone Numbers

Phone Number *

Preferred Contact Method

Gender

Male

Female

Social Security Number

Driver's License Number

Are you currently employed?

Yes

How were you referred to our law firm?

Friend or family member

Another attorney

Online search or lawyer directory website

Billboard, bus stop, phone book, newspaper, or other physical advertisement

Radio or TV advertisement

Bar Association

If our law firm ends up representing you in this matter, will you be the person who pays the legal fees?

Yes

If our law firm ends up representing you in this matter, will you be the person who pays the legal fees?

Yes

ACKNOWLEDGEMENT AND ACCEPTANCE

I acknowledge that I have read and hereby accept the above privacy policy regarding use of my personal information.

Contact Information: About the Proposed Co-Guardian (if any)

First Name:

Middle Name:

Last Name:

Date of Birth

Company

Emails

Email Address

Type

Address

Street Address

Country

City

State/Region

Zip/Postal Code

Address Type

Work

Billing

Home

Other

Phone Number

Phone Number

Type

Contact Information: About the Biological Mother

First Name:

Middle Name:

Last Name:

Date of Birth

Company

Emails

Email Address

Type

Address

Street Address

City

Country

State/Region

Zip/Postal Code

Address Type

Phone Number

Phone Number

Type

First Name:

Middle Name:

Last Name:

Date of Birth

Company

Email

Email Address:

Type

Address

Street Address

Country

City

State/Region

Zip/Postal Code

Phone Number

Phone Number

Type country/area code first

Type

Contact Information: About the Biological Father

First Name:

Middle Name:

Last Name:

Date of Birth

Company

Email

Email Address:

Type

Address

Street Address

Country

City

State/Region

Zip/Postal Code

Phone Numbers

Phone Number Type country/area code first

Type

Does Mother Have a History of Drug or Alcohol Abuse?

Yes

Does Father Have a History of Drug or Alcohol Abuse?

Yes

Has Mother Been Incarcerated?

Yes

THANK YOU

Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We will contact you as soon as possible with any updates.

Please click the SUBMIT button after you have finished answering all of the questions.