Intake Form

Family Law Intake Form

*Name:

*Address:

*City:

*State:

*Zip:

*E-mail address:

*Home Phone:

Business Phone:

Cellular or Pager:

Facsimile:

What type of family law matter are you interested in?

Are you currently married or cohabiting?
Yes  No 

Check one:
Married  Cohabiting 

If yes, list his or her name, date of birth, and date of marriage/cohabitation:

Do you have children?
Yes  No 

If yes, list their names and dates of birth:

Name Date of Birth

If you have children, with whom and where do they live now?

Were you previously married?
Yes  No 

If yes, when and how did your previous marriage(s) end?

Is your case contested or do you anticipate you will meet opposition to your anticipated actions?
Yes  No 

Have you been served with papers in a family law matter?
Yes  No 

If yes, what is the name of the opposing party and his or her attorney (if known)?

What is your relationship with the opposing party?

If "Other Relationship," please explain:

Have you appeared in court or agreed on terms related to this matter?
Yes  No 

Do you have copies of any documents (court decrees, dissolution agreements, etc.) related to this matter?
Yes  No 

What types of documents do you have?

Is domestic violence an issue in this matter?
Yes  No 

If yes, please describe, including any court actions and incident dates.

Is property at issue?
Yes  No 

If yes, please describe the property and anything known with regard to legal ownership.

Are you or any person involved in this matter currently pregnant?
Yes  No 

Where did you hear about this website?

 

The contents of this contact form are provided by and are the responsibility of the person posting the email communication. Your email will not create an attorney-client relationship and will not necessarily be treated as privileged or confidential. You acknowledge that any reliance on material in email communications is at your own risk.

The law office of Amy M. Levine & Associates provides quality family law and criminal defense representation for residents of West Virginia and Ohio communities, including communities such as Columbus, Whitehall, Hilliard, Worthington, Upper Arlington, New Albany, Westerville, Gahanna, Groveport, Grove City, Pickerington, Ironton, Southpoint, and Chesapeake, and Huntington and Wayne. We also provide bankruptcy representation for residents of Ohio.

Madison County • Delaware County • Franklin County • Fairfield County • Licking County • Lawrence County • Cabell County • Wayne County


Contact Us

Columbus Office
147 Thurman Avenue
Columbus, OH 43206
Phone: 614-224-5291
Fax: 614-224-5299

Huntington Office
1330 Commerce Avenue
Suite 1
Huntington, WV25701
Phone: 304-399-3200
Fax: 304-522-6954

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