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Family Law Intake Questionnaire
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CLIENT INFORMATION: Name
*
First
Middle
Last
Other Names (Maiden, Nicknames, Aliases, Etc.)
Address
*
County Of Residence
Date of Birth:
*
Social Security No:
Are you a U.S. Citizen?
YES
NO
Are you a Georgia Resident?
YES
NO
***Mailing Address (if different)
Email
*
Primary Telephone
*
Primary Telephone Service:
Cellular
Home
Work
Secondary Telephone:
Secondary Telephone Service:
Cellular
Home
Work
Occupation/Employer
Employer Address
Employer Telephone
Military Service Status
Not Applicable
Active
Retired
Educational Background
High School
College
Other
Special Skills/Certificates
OTHER PARTY INFORMATION: Name
*
First
Middle
Last
Date of Birth: (Other Party)
Social Security No: (Other Party)
Is the Other Party A U.S. Citizen?
YES
NO
Is The Other Party A Georgia Resident?
YES
NO
Other Party Address:
Military Service Status (Other Party)
Not Applicable
Active
Retired
Educational Background (Other Party)
High School
College
Other
Occupation/Employer (Other Party)
Employer Address (Other Party)
Employer Telephone (Other Party)
Other Party's Attorney (If Applicable)
RELATIONSHIP INFORMATION: Date Relationship Began
Date/County/State of Marriage
Date of Separation: (Approximate)
Details of Separation
Previous Divorce(s), Separation(s), Annulment(s)?
NOT APPLICABLE
YES
NO
County, State Where Suit Was Filed (If Applicable)
Date Prior Action Commenced:
Date Prior Action Ended:
CHILD(REN) FROM THIS RELATIONSHIP: 1st Child Name
First
Middle
Last
1st Child Date of Birth:
2nd Child Name
First
Middle
Last
2nd Child Date of Birth:
3rd Child Name
First
Middle
Last
3rd Child Date of Birth:
Are You Expecting Another Child?
YES
NO
Has DNA been completed on the minor child(ren)?
YES
NO
Has The Father Signed The Birth Certificate(s)?
YES
NO
Has The Father Completed A Petition for Legitimation? (Court Document Granting Legal Rights To Father-Not the Same as Child Support)
YES
NO
Is There A Court Order For Child Support In Any Court?
YES
NO
If Yes, Please Provide The Date Of The Court Order And How Payment Is Received
Etc.) Details You,
Do You Have Minor Child(ren) From A Prior Relationship?
YES
NO
PENDING LEGAL MATTERS: Is An Action For Cusotdy/Child Support/ Legitimation Filed?
YES
NO
If Yes, who filed the action?
Date The Action Was Filed
County The Action Was Filed
Case Number Of Suit:
If The Action Was Filed Against You, Have You Filed An Answer/Response To The Suit?
YES
NO
Allegations/Facts Of Suit
Submit
