Confidential Client Intake Form

Client Information
Case Number/County
Name*
First Last
Names Used in the Past
Address*
Street Address City State ZIP Code
Date of Birth
Phone Number*
Email*
Employer
Job Title
Information About My Spouse, Former Spouse, or Child(ren's) Other Parent
( The other party in your case )
Name*
First Last
Names Used in the Past
Address
Street Address City State ZIP Code
Date of Birth
Phone
Email
Employer
Job Title
Marriage and Family Information
Date of Marriage
Date of Separation
Please list minor children of THIS marriage/relationship.
Child's Name (1)
Date of Birth (1)
Gender (1)
Place of Birth (1)
Child's Name (2)
Date of Birth (2)
Gender (2)
Place of Birth (2)
Child's Name (3)
Date of Birth (3)
Gender (3)
Place of Birth (3)
Emergency Orders
I feel I need emergency orders because:
My spouse is violent. He or she has:
Untitled
- Actually hit me or threatened to cause me physical harm
- Threatened me or a member of my family with a weapon
- I fear for my personal safety and/or the safety of my child(ren)
- My spouse has threatened to take our child(ren) away
- Actually hit the CHILD(REN) or threatened to cause the CHILD(REN) physical harm
- I believe my spouse will continue to actually hit me and/or carry out the threats
My spouse abuses:
- Alcohol
- Drugs
Additional Information
Any other information you’d like the attorney to know about your case?
Documents You Would Like Reviewed
(Prior Relevant Orders, Pending Motions, Etc.)
Drop files here or

Max. file size: 32 MB.
Phone
This field is for validation purposes and should be left unchanged.

Estate Planning, Probate & Family Law | Santa Clara County, CA

Estate Planning, Probate & Family Law | Santa Clara County, CA

Confidential Client Intake Form

Client Information

Information About My Spouse, Former Spouse, or Child(ren's) Other Parent

Marriage and Family Information

Emergency Orders