Cordell Client Intake Form
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Please note: This form will be unavailable from 8:30pm to 9:30pm CST on 11/10/14 as we perform routine server maintenance. We recommend that you do not begin filling out this form between 8:00pm and 9:30pm CST to prevent any disruption of your work.
This form is to be completed by clients of Cordell & Cordell prior to their initial consultation. If you have not yet scheduled an initial consultation, please call 1-866-DADS-LAW to speak with a scheduling representative.

Your Information

First Name: Middle Name: Last Name:
Confidential Address: All correspondence from this office will be sent to this address – be sure it is secure. (Do not list an address where mail could be retrieved by the other party or anyone else; rather, give us a safe address, or call us later when you obtain a secure address.)
Address:
City: State: Zip:
County of Home Address: Years at this Address: Months at this Address:
Date of Birth: Social Security No:
Contact Information: Do not list a number or email where calls, emails or pages could be received by the other party or anyone you do not want receiving them; rather, give a safe number or email address, or call us later when you obtain safe contact information. We HIGHLY suggest that you create a new email account with a new password for any communications with us.
Work Phone: Cell Phone: Home Phone: Email address:

Reason for Consultation:


Additional information on your reason for consultation:

Opposing Party

First Name: Middle Name: Last Name: Maiden Name:
Address:
City: State: Zip:
County of Home Address: Years at this Address: Months at this Address:
Date of Birth: SSN:

Marriage History

What is your current relationship with the opposing party?


Are you and the opposing party living together?

Date of separation:

Prior Marriages

If you and/or the opposing party have been married before, list the names of prior spouse(s), how the prior marriage(s) ended, the date it ended, and if there are other children not of this marriage/relationship:

Your Children

How many children do you have?

Your Employment

Are you employed?
Annual Salary If unemployed, last job:

Employment of Opposing Party

Is the opposing party employed?
Annual Salary If unemployed, last job:

Education

Please list below the highest level of education/training for you and the opposing party:

You:


Opposing Party:

Other:

Has the opposing party consulted an attorney regarding this matter?
Name of attorney, if known: Address of attorney, if known:

Have you signed anything, which may affect this case, including prenuptial or postnuptial agreement(s), or other documents presented by the opposing party?

If so, please describe the document:


Are there any pending court dates?

If yes, state type of court setting, date and location:


Do you have any potential/pending personal injury/worker compensation claims?


Are there any existing Court or Administrative Orders with this opposing party?


Are you and/or the opposing party both U.S. Citizens?


Are you or the opposing party a member of the Armed Forces of the United States on active duty?


Do you or the opposing party have a Facebook or Twitter account?
How did you hear about us? Referral details (specific radio station, TV station, employee or web site):