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Family Law Intake, Start Your Journey, Brandon Legal Group

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Family Law Intake General Information
Please complete this questionnaire and return it to our office before your first appointment. If you will spend the time to complete all items, we will then have the necessary background information to understand the complexity of the personal aspects of your situation. All information will be held in the strictest confidence. Some of this information may not apply to you; if so, simply indicate N/A (not applicable) where appropriate. Thank you!
Nature of current legal issue*
If other please specify
Method of Referral
We like to express our appreciation to the clients and attorneys that may have referred you to us. Please help us do that by advising how you heard about us. Please provide complete name.
How did you hear about our office?*
Referral Name
If Other please specify

Your Information
Name*
First Last
Gender*
- Male
- Female
- Prefer Not To Say
Maiden Name (If Applicable)
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is this the marital address?
- Yes
- No
Driver's License / ID Number*
* Please attach copy of Driver’s License or other government issued ID. (For in person consults, photocopy can. Be completed at time of appointment if necessary)
Photo/ Photocopy of your Drivers License
Max. file size: 100 MB.
Main Phone*
Other Phone
Email
Date of Birth*
MM slash DD slash YYYY
SSN*
Your Military Affiliation
Are you Active Duty or Retired Military*
- Yes Active Duty
- Yes Retired Military
- No
If Active, where are you stationed?
Do you receive Military Disability pay?
- Yes
- No
What is your Disability Rating (%) and for what conditions?
Your Occupation
Are You Employed?
- Yes
- No
Your Employer*
Employer Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employer Phone
Job Title*
* If you are a gig worker (Uber, Fiverr, Lyft, etc.) enter GIG WORKER. If you are self-employed, enter SELF
Annual Gross Income*
Your Health Insurance
Do you have health insurance covering yourself?*
- Yes
- No
Healthcare cost per month for only you

Other Party's Information
Other Party's Name*
First Last
Gender*
- Male
- Female
- Prefer Not To Say
Do both you and the other party presently live in the same home?
- Yes
- No
Address
Same address as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Other Party's Address
- Enter Other Party's Address
- Unknown
Enter Other Party's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Date of Birth*
MM slash DD slash YYYY
SSN
Other Party's Military Affiliation
Are they Active Duty Military*
- Yes
- No
Where are they stationed?
Other Party’s Attorney Information
Is the other party represented by an attorney?*
- Yes
- No
- Don't Know
Please provide the name of the Attorney/ Law Firm
Other Party’s Occupation
Is Other Party Employed*
- Yes
- No
Other Party’s Employer*
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employer Phone
Job Title
* If you are a gig worker (Uber, Fiverr, Lyft, etc.) enter GIG WORKER. If you are self-employed, enter SELF
Annual Gross Income

Current Marital Background
Current Marital Status*
- Married
- Divorced
- Separated
- Single
- Widowed
Current Marital Status*
- Married
- Divorced
- Separated
Date of Marriage
MM slash DD slash YYYY
Place of Marriage (City, State)
Date of Separation
MM slash DD slash YYYY
Location Of Separation (City, State)
Have both of the parties lived in Florida for at least six (6) months prior to this date?*
- Yes
- No
Date of Marriage
MM slash DD slash YYYY
If either party has resided in Florida for at least six (6) months, please indicate the State of residence for the six (6) month period before moving to Florida
Date of Move to Florida
MM slash DD slash YYYY
Have Proceedings started?*
- Yes
- No
This field is hidden when viewing the form
Have you been served divorce papers?*
- Yes
- No
When and Where were you served?
This field is hidden when viewing the form
Domestic Violence / Counseling History
This field is hidden when viewing the form
Has there been Domestic Violence in this relationship?*
- Yes
- No
This field is hidden when viewing the form
Is there a Domestic Violence Injunction currently in place or has there previously been one in place?
- Yes
- No
This field is hidden when viewing the form
Please Explain (Location, Case Number and Current Status)
This field is hidden when viewing the form
Is there a Police Report?
- Yes
- No
This field is hidden when viewing the form
If available please provide a copy of Police Report
Max. file size: 100 MB.
This field is hidden when viewing the form
Have either of you had marital/couples or individual counseling?*
- Yes, Me Only
- Yes, Other Party Only
- Both
- Niether
Other Related Cases
Are there any other related cases involving either of the parties?*
- Yes
- No
Please Explain

Children from Current Marriage and/or Relationship
This field is hidden when viewing the form
Is the wife/mother currently pregnant?
- Yes
- No
This field is hidden when viewing the form
Due Date
MM slash DD slash YYYY
Are there children born of this marriage and/or relationship?*
- Yes
- No
How Many Children?
Please provide children’s full names, date of birth, birthplace (hospital city and state) and ssn
This field is hidden when viewing the form
Please provide each child's Name, Date of Birth, SSN# and Address(s) for the last 5 years
With whom do(es) the child(ren) reside?
- You
- Jointly in the Marital Home
- Other Party
- Shared
- Other
Please provide the name and address of this individual(s)
Have there been any prior court actions involving this/these child(ren)?
- Yes
- No
Please provide the following: (Type of Action, The Case Number, Current Status, and the County and State of the court)
Do you and the other party have any type of agreement, verbal or written regarding parental responsibility of this child(ren)?
- Yes
- No
Please provide the details of that agreement
Please upload a copy of the agreement if available.
Max. file size: 100 MB.
What are you seeking as to parental responsibility?
- Shared Parental Responsibility
- Sole Parental Responsibility
What are "YOU" seeking as to time-sharing? (ex. 50/50 every other week, 100% of the time, weekends only…)Please Specify the Time for You and the Other Parent
Do(es) any child(ren) have any special medical, educational, or developmental needs?
- Yes
- No
Please provide the nature of those needs
Is health, dental and/or optical insurance available for the child(ren)?
- Health
- Dental
- Optical
- No
Who Pays for health, dental and/or optical insurance
- Me
- Other Person
What is the monthly health insurance expense?

Real Estate - Residential
Is the Marital Home Rented or Owned?
- Rented
- Owned
Do either of you, jointly or separately, own more real estate property, that is NOT income-producing (vacation home, timeshare, etc.)?
- Yes
- No
Please provide details of the non-income producing properties
Mortgage Information
Whose name is on the title?
Who made the down payment?
- You
- Other Party
- Joint Funds
Who holds the mortgage?
Mortgage payment amount
Is mortgage payment current?
- Yes
- No
- Don't Know
Approximate mortgage balance
Approximate home value
Who makes the mortgage payments?
- You
- Other Party
- Joint Funds
Please use the space below to provide additional information if more than 1 property is relevant, including whether the property was purchased prior to, or after the marriage, Date of purchase, Name on Title, Who made the down payment, who holds the mortgage, mortgage amount, is the mortgage current, approximate mortgage balance, approximate property value, and who makes the mortgage payments, to the best of your ability.
Rental/Income Properties
Do either of you, jointly or separately own any properties which produce income/rents?*
- Yes
- No
Please Provide details of the income producing properties
This field is hidden when viewing the form
How Many Rental Properties?
- 1
- 2
- 3
- 4
- More
This field is hidden when viewing the form
Please describe the properties, mortgages and net incomes of the other properties
This field is hidden when viewing the form
Who owns the property?
- You
- Other Party
- Jointly
Please Check all that apply
This field is hidden when viewing the form
Whose name is on the title?
This field is hidden when viewing the form
Who made the down payment?
- You
- Other Party
- Joint Funds
This field is hidden when viewing the form
Who holds the mortgage?
This field is hidden when viewing the form
Mortgage payment amount
This field is hidden when viewing the form
Is mortgage payment current?
- Yes
- No
- Don't Know
This field is hidden when viewing the form
Mortgage balance (if known)
This field is hidden when viewing the form
Approximate home value
This field is hidden when viewing the form
Who makes the mortgage payments?
- You
- Other Party
- Joint Funds
This field is hidden when viewing the form
Net Monthly income from this property
This field is hidden when viewing the form
Can you provide an income-expense statement?
- Yes
- No
This field is hidden when viewing the form
If income-expense statement is available please upload here
Max. file size: 100 MB.
If not available digitally please bring a copy with you to your consultation
This field is hidden when viewing the form
Please use the space below to provide additional information if there is more than one rental/income property

Personal Property
Do you have personal property relevant to this action?
- Yes
- No
Please explain the nature of the property, its approximate value, and how you would want the property to be divided.

Any Other Information We May Need to Know but Not Addressed
Any additional Information
Any additional documentation
Drop files here or

Max. file size: 100 MB.
Consent
I agree to the privacy policy.
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Hours:
Monday –       8:00am – 5:00pm
Tuesday –       8:00am – 5:00pm
Wedensday – 8:00am – 5:00pm
Thursday –     8:00am – 5:00pm
Friday –           8:00am – 5:00pm
Saturday –            Closed
Sunday –               Closed

CONTACTS

phone:
(813) 902-3576
email:
service@brandonlegalgroup.com

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Brandon Office

A full service law firm
1209 Lakeside Drive
Brandon FL, 33510

THE BLG DIFFERENCE

Our skill sets allow us to provide many legal services to our clients and to resolve complex legal issues that are often intertwined. We are able to leverage our internal resources to maintain most matters in-house with a few exceptions where we can call on experienced colleagues for assistance. Without the need to outsource most matters, we have the opportunity to settle your matter more quickly and cost efficiently.

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Family Law Client Intake Form – Brandon Legal Group

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