Accutive | Cybersecurity & FinTech Solutions - Questionnaire

Welcome to Accutive_Global Family Law Firm

Potential New Client Information Form

Date *

Meet with Attorney: *

First Name *

Middle Name

Last Name *

Your Address: *

City *

County of Residence *

State *

Zip *

Your Email Address (to receive email): *

Password *

Preferred phone contact number *

Phone Number:

Home Phone Number *

Work Phone Number *

Cell Phone Number *

Please fill in the phone number of the person to contact in case of emergency: *

Referred By: *

Case Type (Choose one):

Has anything been filed? *

✓

Yes

✓

No

Are there children? *

✓

Yes

✓

No

Do you or any potential party to this lawsuit own or possess any firearms (including component parts thereof) or ammunition (including primers, casings, bullets, and/or powder)? *

✓

Yes

✓

No

Do you or any potential party to this lawsuit possess a license giving the right to carry a concealed weapon? *

✓

Yes

✓

No

potential new client form Payment
potential new client form Payment

potential new client form Payment

Please indicate how you will be paying today: *

Family Law Intake Plans
Family Law Intake Plans

Thank you for visiting our Digital Intake.

Please let us know what you are here for and select all that apply.

Divorce Enforcement Child Related Paterny Prenuptial Other

Other Information *

Have you met with another attorney? *

✓

Yes

✓

No

Divorce
The Divorce intake screen helps clients start a divorce case by selecting “Divorce” and providing basic details about the marriage, separation, children (if any), and key financial information. This allows the firm to understand the client’s situation quickly and guide the next steps.

Please give the date and place of your marriage.

Date: *

Place *

Are you now separated from your spouse? *

If so, please state the date of separation: *

Have you seen a marriage counselor? *

If so, please state name of counselor: *

Are you currently seeing a counselor/psychiatrist/psychologist? *

✓

Yes

✓

No

What is the reason you visit?

Marriage and Separation
Marriage and Separation

Check as appropriate if your marital difficulties involve any of the following:

Drugs/Alcohol Sexual Disappointment Infidelity Financial Dispute Physical Violence Religion Incompatibility Emotional Abuse Other

Have you or your spouse ever filed for divorce in this marriage?

✓

Yes

✓

No

Does your spouse have an attorney?

✓

Yes

✓

No

Have you been married before?

✓

Yes

✓

No

Assets/Debt/Real Estate
Please provide information regarding the assets you own. This information helps our firm to understand the size of your estate, where your assets are held, debts you may owe, and any business interests. All these factors affect the planning and recommendations that our firm provides for you. It is important to provide as much information as possible. If you do not know exact figures, please enter your best estimate or “unknown.” If you are not sure of any asset information, please make a note at the end of this form and we can discuss further during your first appointment.

Do you own Real Estate? *

✓

Yes

✓

No

Do you own investment/non-retirement accounts? *

✓

Yes

✓

No

Do you have business Interests? *

✓

Yes

✓

No

Do you own Cash/Saving Accounts?

✓

Yes

✓

No

Do you own Retirement Accounts?

✓

Yes

✓

No

Do you have Debts?

✓

Yes

✓

No

Do you own Life Insurance Policies? *

✓

Yes

✓

No

Do you work with a financial advisor? *

✓

Yes

✓

No

Do you have any Additional comments? *

✓

Yes

✓

No

Court Information
Your consult fee is due at the time of service ** Please indicate how you will be paying. Below you find the link to make the payment. You can choose to pay via card or echeck. https://secure.lawpay.com/pages/webbfamilylaw/operating

Petitioner Information

First Name *

Middle Name

Last Name *

Email *

Date of Marriage *

Phone Number *

SSN Number * Last 4 digit

Driving License * Last 4 digit

Gender

✓

Male

✓

Female

Full Address: *

City:

State:

County:

Zip Code:

Respondent Information
Respondent Information

Respondent Information

First Name *

Middle Name

Last Name *

Email *

Phone Number *

SSN Number * Last 4 digit

Driving License * Last 4 digit

Gender

✓

Male

✓

Female

Full Address: *

City:

State:

County:

Zip Code:

Children Information
When answering these questions, please answer the questions based on all your children including any step-children.

Are you a parent or legal guardian of a child?

✓

Yes

✓

No

Marriage And Separation:Children Information
When answering these questions, please answer the questions based on all your children including any step-children.

Do you have children by a previous marriage/relationship?

✓

Yes

✓

No

With whom do these children reside? *

Do you pay/receive (circle one) child support? *

✓

Yes

✓

No

Has your spouse been married before? *

✓

Yes

✓

No

Does your spouse have children by a previous marriage/relationship or subsequent marriage/relationship? *

✓

Yes

✓

No

With whom do these children reside? *

Does your spouse pay/receive (circle one) child support? *

✓

Yes

✓

No

Please select "Does your spouse pay/receive (circle one) child support?".

Petitioner Employment Information
Petitioner Employment Information

Currently unemployed *

✓

Yes

✓

No

Is this insurance through your *

employer? Your Spouse? or Private?

Respondent Employment Information
Respondent Employment Information

Currently unemployed *

✓

Yes

✓

No

Is this insurance through your *

employer? Your Spouse? or Private?

Serve Your Spouse
Serve Your Spouse

Would you like to have your spouse served? *

✓

Yes

✓

No

What kind of vehicle does your spouse drive?

Year *

Make *

Model *

Color *

Type *

What is your spouse's schedule? *

Where and when are we likely to find him/her for service of papers? *

Additional Comments *

Submission Screen

Please review your responses. Once you feel that your interview is complete, then click the ‘Submit’ button to submit your digital intake to us.

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