Please fill out this form as comprehensively as possible. Each party should fill out their own intake form. If exact information is not known, please provide your best estimate. You both may be asked at some future date to provide more precise information. Mediation provides a helpful negotiation process for many separating or divorcing couples, however, there are no guarantees, and some couples are not suitable for mediation. The attorney/mediator reserves the right to terminate sessions in the event they are no longer productive and communication between the parties breaks down. There is no confidentiality privilege between individual parties and the attorney/mediator. Confidentiality is protected as it pertains the third parties.

Privacy Policy

Wright Family Law Group 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 us to assist you in your mediation, 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

Contact Information: Your Contact Information

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

Addresses

Street Address

Country

City

State/Region

Zip/Postal Code

Address Type

Phone Numbers

Phone Number *

I agree to terms & conditions provided by the Wrights family law group. By providing my phone number, I agree to receive text messages from the business.

Your Social Security Number

Place of Birth

Are you a U.S. Citizen?

Yes

Home Address (if different from mailing address above)

How long have you lived at your present address?

Type of Residence

Please provide your residential addresses for the previous 2 years

At the Conclusion of Your Divorce do you or Your Spouse Wish to Resume a Maiden Name?

Yes

N/A

Contact Information: Your Spouse's Contact Information

Prefix

First Name:

Last Name

Date of Birth:

Emails

Email Address

Addresses

Street Address

City

Country

State/Region

Zip/Postal Code

Address Type

Phone Number

Phone Number

Type

Employment History

In a divorce, employment information is always relevant because it is an indication of financial stability. From work schedules and the ability to spend time with the children to income and retirement accounts, employment-related issues affect virtually every decision a court makes. In this section, we will be collecting information about you and your spouse's job history.

Are You Employed?

Yes

No - Disabled

No - Retired

Your Employer's Address

Job Title/Nature of Job

Are you Salary or Hourly?

Salary

Hourly

How long have you been at your current job?

Marriage Information

We require information about your marriage in order to complete the court forms required to process your case.

Date of Marriage

Place of Marriage

Are You and Your Spouse Living Together Now?

Yes

Is There a Possibility of Reconciliation With Your Spouse?

Yes

Please State the Date That Your Marriage Became Irretrievably Broken

Please State the Number of Times You Have Been Married Prior to This Marriage

Please Upload a Copy of Your Marriage Certificate (only one spouse needs to do this)

Add attachment

Children of the Marriage

In this section we will be collecting information about your children. If parenting time or custody is in dispute, please provide relevant information in as much detail as possible.

Child 1 Name

Child 1 Gender

Male

Female

Child 1 Date of Birth

Child 1 Lives With

Child 2 Name

Child 2 Gender

Male

Female

Child 2 Date of Birth

Child 2 Lives With

Child 3 Name

Child 3 Gender

Male

Female

Child 3 Date of Birth

Child 3 Lives With

Child 4 Name

Child 4 Gender

Male

Female

Child 4 Date of Birth

Child 4 Lives With

If Any of the Child(ren) Have Been Diagnosed With Any Health, Education, of Behavioral Issues, Please Provide Details Including the Names of any Treatment Providers

If any of Your Children are Seeing a Counselor or Therapist, Please Provide Details

Please Describe the Current Parenting Plan for the Children

Please State in Your Own Words What You Believe is the Highest Priority in This Divorce, and What You Believe Would be the Best Possible Outcome in Your Circumstances

THANK YOU

Thank you so much for completing this intake questionnaire. The information will be extremely helpful in evaluating your case to ensure you and your spouse are good candidates for mediation. We will be in touch with you soon regarding next steps.

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