RESTRAINING ORDER INTAKE

Thank you so much for contacting our law office. Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.

Confidential Client History

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.

If you are the defendant in a restraining order case, you MUST return to the Court where the restraining order was issued and obtain a copy of the affidavit (written statement) that the plaintiff filled out against you. This is essential for our attorneys to review. We cannot book your intake appointment until you have a copy of the plaintiff’s affidavit

Privacy Policy

All information received from a client is strictly confidential. 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.

Your Social Security number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

Social Security numbers are most often used to positively identify parties. Most courts require Social Security numbers of all parties in a case. Some other examples of how this information may be used include:

initial service
in court orders
in required reports or other documents filed with the State

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you.

Referred By:

ABOUT YOU

Contact Information

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 *

How long at current residence?

Is your physical address different than above?

Yes

Social Security Number:

Who May We Contact if we cannot get a hold of you?

Phone Number:

EMPLOYER INFORMATION:

Employer Name:

Employer Address:

Employer Phone Number:

OPPOSING PARTY

First Name:

Last Name:

Middle Initial:

Mailing Address:

City:

State

Zip/Postal Code

How long at current residence?

Home Phone:

Work Phone:

Cell Phone:

Physical address different than above?

Yes

Phone Number

Name of Employer:

Date of Birth

Social Security No,:

Is the opposing party represented by counsel?

Yes

Do you have any children from this Relationship?

Yes

How many children involved?

PRIOR COURT HISTORY

Have you had any prior restraining orders issued against you?

Yes

CURRENT COURT INVOLVEMENT

Name of court where restraining order issued:

Docket #

Date Restraining Order was issued:

Briefly describe the circumstances that led to the Court involvement:

Do you Have in Your Possession:

Copies of Police Reports:

Yes

Photographs:

Yes

*Plaintiff’s Affidavit:

Yes

*Required prior to your hearing

Witness Statements:

Yes

Medical Documentation:

Yes

Other:

CHILDREN

For each child, please select "Yes" and complete the requested information. If it's not applicable, please select "No".

Child 1:

Yes

Does this child have any special health, education or behavioral issues?

Yes

Child 2:

Yes

Does this child have any special health, education or behavioral issues?

Yes

Child 3:

Yes

Does this child have any special health, education or behavioral issues?

Yes

Where is/are the child(ren) residing?

List all addresses where the child(ren) has/have lived for the past three years:

Dates With Whom the Children Lived:

Address:

OTHER INFORMATION

Any other details you would like to tell us about your case:

THANK YOU

We will contact you as soon as possible.

Please click the SUBMIT button when you have finished completing this form.