Divorce Intake Form

DIVORCE INTAKE FORM

This Divorce Intake Form is submitted by Client Name: and identifies Respondent Name: . Intake Date:

RECITALS

WHEREAS, Client intends to initiate, or is contemplating, a legal action for dissolution of marriage against Respondent and seeks to provide preliminary information for legal evaluation and case intake; and

WHEREAS, the information provided in this form will be relied upon by the receiving law office for conflict checks, case assessment, and preparation of initial pleadings, and Client acknowledges the obligation to supplement or correct information as soon as practicable; and

WHEREAS, the parties intend that submission of this form does not, by itself, create an attorney-client relationship unless and until a separate engagement agreement is executed by the attorney and Client.

NOW, THEREFORE, the parties provide the following information and attestations for intake purposes:

1. PARTY CONTACT INFORMATION

2. MARRIAGE AND SEPARATION

Date of Marriage:   Place of Marriage (City, State):

Date of Separation (if applicable):   Currently living (together/separate):

3. CHILDREN

Number of minor children of the marriage:

4. ASSETS, LIABILITIES AND INCOME

Client - Estimated monthly gross income: $   Respondent - Estimated monthly gross income: $

5. RELIEF SOUGHT

Please indicate the forms of relief you anticipate requesting (check all that apply):

Contested divorce    Uncontested divorce

Child custody / parenting plan    Child support

Spousal support / maintenance    Property division    Legal name change

6. PRIOR PROCEEDINGS & LEGAL REPRESENTATION

7. NOTICES

All formal notices and pleadings shall be delivered to the addresses listed above unless the parties provide written notice of a change in accordance with the Notices clause below.

8. CERTIFICATIONS AND AUTHORIZATIONS

By completing and submitting this form, Client certifies under penalty of perjury that the information provided herein is true, correct and complete to the best of Client's knowledge. Client understands that material omissions or false statements may affect legal strategy and may be subject to sanctions under the rules of civil procedure and applicable law.

Client authorizes the receiving law office to perform conflict checks, to obtain relevant financial and background information necessary for case evaluation, and to contact third parties or former counsel as reasonably required for intake purposes. Such authorization is limited to matters directly related to the intake and preliminary assessment and does not constitute a waiver of any rights or claims.

Client acknowledges that execution of this Intake Form is not an engagement agreement for legal services and that a separate written engagement agreement will be required to establish attorney-client representation and fee terms.

9. MISCELLANEOUS PROVISIONS

Governing Law: This Intake Form and any dispute relating to the sufficiency or handling of the information supplied herein shall be governed by and construed in accordance with the laws of the state where the receiving law office maintains its principal place of business, without regard to its conflict-of-law rules.

Entire Agreement: This document constitutes the entire written record of the intake information supplied by Client for case assessment and supersedes all prior intake communications between the parties regarding the subject matter hereof.

Severability: If any provision of this Intake Form is held to be invalid or unenforceable, the remaining provisions shall continue in full force and effect to the maximum extent permitted by law.

Amendments and Waiver: Any amendment to or waiver of a provision of this Intake Form must be in writing and signed by Client and an authorized representative of the receiving law office. No failure or delay by either party in exercising any right shall operate as a waiver of that right.

Counterparts: This Intake Form may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

10. ACKNOWLEDGMENT OF MATERIALS PROVIDED

Client acknowledges that Client has provided copies or descriptions of material documents relevant to the matter, including but not limited to financial statements, tax returns, property deeds, and prior pleadings if applicable. Client agrees to promptly supplement any missing documents as requested.

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