Family Law Intake Form

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Details Name Please enter your name.

Street Address Please enter your street address.

City Please enter the name of your city.

State Please choose your state of residence. ZIP Code Please enter a valid ZIP code. You may use 0-9, spaces and the ( ) - + characters.

E-mail Address

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Home Phone Number Please enter a valid home phone number. You may use 0-9, spaces and the ( ) - + characters.

Business Phone Number Please enter a valid business phone number. You may use 0-9, spaces and the ( ) - + characters.

Mobile Phone Number Please enter a valid mobile phone number. You may use 0-9, spaces and the ( ) - + characters.

Fax Number Please enter a valid fax number. You may use 0-9, spaces and the ( ) - + characters.

What area of family law does this concern? Please indicate what area of family law most resembles your issue.

Please indicate whether you are married, cohabiting or neither. I am currently married.

I am currently cohabiting.

I am not married or cohabiting.

If you are currently married or cohabiting with another person, please enter his or her name, date of birth and date of marriage or start of cohabitation. Please enter his or her name, date of birth and date of marriage or start of cohabitation.

Do you have children? I have children.

I do not have children.

Children Please enter the name of your first child. Please enter the name of your first child.

Please enter your first child's date of birth. Please enter your first child's date of birth.

Please enter the name of your second child. Please enter the name of your second child.

Please enter your second child's date of birth. Please enter your second child's date of birth.

Please enter the name of your third child. Please enter the name of your third child.

Please enter your third child's date of birth. Please enter your third child's date of birth.

Please enter the name of your fourth child. Please enter the name of your fourth child.

Please enter your fourth child's date of birth. Please enter your fourth child's date of birth.

If you have children, please describe with whom they are living and where they are living. Please describe with whom they are living and where they are living.

Were you previously married? I was previously married.

I was never married.

If you have been previously married, please describe when and how your marriage(s) ended. Please describe when and how your marriage(s) ended.

Please indicate if your case is contested or if you anticipate you will meet opposition to your anticipated actions. My case is contested or I anticipate I will meet opposition to my anticipated actions.

My case is not contested and I do not anticipate I will meet any opposition to my anticipated actions.

Please indicate if have been served papers involving a family law matter. I have been served papers involving a family law matter.

I have not been served any papers involving a family law matter.

If you have been served papers involving a family law matter, please enter the name of the opposing party. Please enter the name of the opposing party.

If you have been served papers involving a family law matter, please enter the name of the opposing party's attorney (if known). Please enter the name of the opposing party's attorney (if known).

If you have been served papers involving a family law matter, please indicate your relationship with the opposing party. Please indicate your relationship with the opposing party. If you have been served papers involving a family law matter and you are not their spouse, former spouse, cohabitant or co-parent, please describe your relationship to the opposing party. Please describe your relationship to the opposing party.

Please indicate if you have appeared in court or agreed to terms related to this matter. I have appeared in court or agreed to terms related to this matter.

I have not appeared in court nor have I agreed to terms related to this matter.

Do you have copies of any documents (court decrees, dissolution agreements, etc.) related to this matter? I have copies of documents (court decrees, dissolution agreements, etc.) related to this matter.

I do not have copies of any documents related to this matter.

If you have copies of any documents (court decrees, dissolution agreements, etc.) related to this matter, please describe those documents. Please describe the documents you have that are related to this matter.

Is domestic violence involved in this matter? This matter involves domestic violence.

This matter does not involve domestic violence.

If domestic violence is involved in this matter, please describe any incidents (including incident dates) and any court actions. Please describe any domestic violence incidents (including incident dates) and any related court actions.

Is property involved in this matter? Property is an issue in this matter.

Property is not an issue in this matter.

If property is an issue in this matter, please describe the property and any information regarding legal ownership. Please describe the property and any information regarding legal ownership.

Are you or any person involved in this matter currently pregnant? I am current pregnant or someone involved is currently pregnant.

No one involved is currently pregnant.

Describe any special concerns. Please describe any special concerns.

How did you hear about this Web site? How did you hear about this Web site? Please choose one.

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

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Contact Information Name

E-mail Address Please enter a valid e-mail address.

Phone

Brief description of your legal issue

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AVALLONE LAW ASSOCIATES
215 South Broad Street
Fifth Floor
Philadelphia, PA 19107

Local: 215-253-3855
Toll Free: 877-223-0579
Fax: 215-545-3817

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Avallone Law Associates serves clients throughout the Greater Philadelphia Area, Delaware County, Montgomery County, Lehigh County, Bucks County, Chester County, Pike County, Philadelphia County, Lancaster County, Berks County, Northampton County, Luzerne County, nearby portions of New Jersey and eastern Pennsylvania communities such as Media, Norristown, Milford, West Chester, Doylestown, Drexel Hill, King of Prussia, Darby, Sharon Hill, Willow Grove, Bryn Mawr, Springfield, Lancaster, Reading, Allentown, Easton, Macungie, Wilkes Barre and Bethlehem.

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