DOMESTIC INTAKE

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

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.

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you. If a question does apply, then please just leave it blank. If you are currently married, please include the name of the opposing spouse. If you are not married, please include the name of the opposing parent. Please fill out all information as best as you you can. If there are children that are involved in the particular litigation you are consulting, please include their information and a you can note at the end the relation of the child or children.

Contact information

Prefix

First name *

Middle name

Last name *

Date of birth

Emails

Email Address *

Type

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

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

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Phone numbers

Phone number

Type

Add phone number

Date:

How did you find me?:

CLIENT INFORMATION

Contact information

Birthplace:

Age:

I have been a resident of South Carolina since:

# of years:

Send correspondence to:

Employer(CompanyName):

Employer Address:

Employer Telephone:

With current employer since:

Current Position:

Wage/Salary:

Pay Frequently:

Other Income:

Your General Health:

Number of this marriage:

*If this is not your first marriage, please see the section called "Particulars of your Prior Marriage(s)"

OPPOSING SPOUSE'S/OPPOSING PARENT'S/OPPOSING PARTY INFORMATION

Full Name:

Birthplace:

Date of Birth:

Has been a resident of South Carolina since:

# of years:

Home Address:

Home telephone:

Cell phone

Fax:

Email:

Employer(CompanyName):

Employer Address:

Employer Telephone:

With current employer since:

Current Position:

Wage/Salary:

Pay Frequently:

Other Income:

General Health:

Number of this marriage:

*If this is not his or her first marriage, please see the section called "Particulars of your Prior Marriage(s)"

PARTICULARS OF YOUR CURRENT MARRIAGE

Wife's maiden name:

Date married:

City, County and State:

Date of separation:

Location last resided together:

CHILDREN SUBJECT TO THE REASON OF YOUR CONSULT

Child #1:

Child #2:

Child #3:

Child #4:

PARTICULARS OF YOUR PRIOR MARRIAGE(S)

First Spouse

First spouse's full name:

Date married:

City and State:

Marriage ended by:

Year:

Number of children from first marriage:

Full name, sex, and age for each child from first marriage:

Child support amount of $:

Currently being:

Alimony amount of $:

Currently being:

Second spouse

Second spouse's full name:

Date married:

City and State:

Marriage ended by:

Year:

Number of children from second marriage:

Full name, sex, and age for each child from second marriage:

Child support amount of $:

Currently being:

Alimony amount of $:

Currently being:

I am interested in knowing more about:

If other, please specify: