Family Law Intake Form

Client Information

First Name

Last Name

Phone *

Email *

Street Address

City

State

Country

Postal Code

Date of birth

Social Security Number

How did you hear about us?

Employment Information

Are you Employed? *

Sí

No

Employer's Name

Position

How long with this company?

Employer's Mailing Address

Matter Details

Type of Law

Type of Matter(s)

Matter Description

Case Number

Judge Assignment / County

Have you had prior counsel regarding this matter?

Sí

No

Prior Attorney Details

Secondary Contact (Required)

*Please list a trusted person who can reliably get a message to you on short notice if we’re unable to reach you. This should not be a second phone number for yourself. Include their name, relationship, and phone number.

Can you please provide a backup contact? *

Sí

No

Secondary Contact: Full Name

Secondary Contact: Email Address

Secondary Contact: Phone Number

Secondary Contact: Full Address

Secondary Contact: Relation to You

Opposing Party Information

Can you provide information about the opposing party? *

Yes

No

Opposing Party: Full Name

Opposing Party: Email Address

Opposing Party: Phone Number

Opposing Party: Date of Birth

Opposing Party: Full Address

Is Opposing Party Employed?

Sí

No

Opposing Party: Employed Information

Does Opposing Party have an Attorney?

Yes

No

Not Sure

Opposing Party: Attorney Information

Marriage Information

Child(ren) Information

Are there Child(ren) involved in this matter? *

Sí

No

How many Children?

Child Custody

Child Support

Assets & Debt

Spousal Maintenance

Temporary Orders

Modification

Past Due Child Support (Contempt)

Supporting Document Upload

Attachment

Please upload any documents relevant to this matter.

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*By scheduling and attending a consultation with Gillespie, Shields & Taylor, I also acknowledge that I am responsible for the consultation fee as outlined. This fee is due regardless of the outcome of the consultation, and I agree not to dispute this charge after services have been rendered.