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General Information

Write “N/A” if the section is Not Applicable to your case

* Your Name (last, first, middle)

* Address

* City

* State

* Zip Code

Phone (Home)

* Phone (Cell)

Maiden Name

Wish to restore maiden name?

* Email

* Date of Birth

* State of Residence

* Length of Residence in Colorado

* Opposing Party’s Name

* Opposing Party’s Address

* City

* State

* Zip Code

* Date of Birth

* Opposing Party’s Attorney (if any)

Children of the Marriage (Names, Dates of Birth & Current address)

Specific Matter Information

Write “N/A” if the section is Not Applicable to your case

New Case or Existing Case

Case Number and County

Any upcoming hearings scheduled?

* Briefly explain what you may need advice about or assistance with today (Divorce, Defamation, Drug Charges, etc.)

* Is the Wife Currently Pregnant

Date of Marriage

* County and State of Marriage

Date of Separation (if applicable)

* Any Restraining Orders (If yes provide name of restrained party, case #, date, etc)

* Is the Department of Humans Services currently involved or has it been involved in the past

Employment Information

You:

* Employer

* Job Title or Occupation

* Work Phone Number

* May we contact you here

* Gross Annual Pay

* Date Last Worked

* Member of the Armed Forces (If so, please state Branch of Service and Rank)

Opposing Party:

* Employer

* Job Title or Occupation

* Work Phone Number

* Gross Annual Pay

* Date Last Worked

* Member of the Armed Forces (If so, please state Branch of Service and Rank)

* Please list any and all current and past attorneys and law firms associated with your case, including those who have represented you or opposing party.

Attorney Fees – Retainer

Retainer and other instructions goes here

* Based upon this information, do you have the financial ability and/or third party financial support available to you in the event you wish to retain this law firm?

How did you hear about our Firm?
(A Friend, Internet Search, Radio Advertisement, AVVO, Former Client or Present Client)

NOTICE: This office does not represent you with regard to the matters set forth by you herein in this INITIAL MATTER EVALUATION until both you and the Firm enter into a Legal Representation Agreement and the Initial Retainer has been paid.

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