Skip to content
Home
Intake Form
About Judith Weigle
Speaker
Recipe for a Heart Healthy Divorce
Driven To Distraction – The Relationship between Presenteeism, Lost Productivity and Divorce
Raising the Bar on the Attorney Brand – For Attorneys
Raising The Bar on the Attorney Brand – For Law Schools
Interviews/Blog
Reviews
Podcast
Resources
Home
Intake Form
About Judith Weigle
Speaker
Recipe for a Heart Healthy Divorce
Driven To Distraction – The Relationship between Presenteeism, Lost Productivity and Divorce
Raising the Bar on the Attorney Brand – For Attorneys
Raising The Bar on the Attorney Brand – For Law Schools
Interviews/Blog
Reviews
Podcast
Resources
Date
Referred By
Your Legal Name on Driver's License
Home Phone
Address
Cell Phone
City, State, Zip
Email
Date of Birth
Spouse's Legal Name on Driver's License
Home Phone
Address
Cell Phone
City, State, Zip
Email
Date of Birth
Date of Marriage
Date of Separation
Will Wife's Former Name be Restored?
Yes
No
Former Name
Have there been issues of domestic violence?
Yes
No
Is there a restraining order in place?
Yes
No
Children:
Name (include Middle Name and Suffix)
Date of Birth
Sex: M or F
Place of Birth (City, State)
Name #2
Date of Birth #2
Sex #2
Place of Birth #2
Name #3
Date of Birth #3
Sex #3
Place of Birth #3
Name #4
Date of Birth #4
Sex #4
Place of Birth #4
Custody and Visitation:
A. Legal (Decision making power over education, health, religion, travel, and extracurricular activities)
Mother
Father
Joint
B. Physical (Where the child will reside and spend significant periods of physical custody)
Mother
Father
Joint
C. Visitation Granted To
Mother
Father
Joint
Addresses Where Children Lived During the Past Five Years?
Period of Residence (Mo/Yr to Mo/Yr)
Address
Period of Residence #2
Address #2
Period of Residence #3
Address #3
Will there be child support?
Yes
No
Not Sure
Will there be spousal support?
Yes
No
Not Sure
Type of Case
Divorce
Summary Dissolution
Legal Separation
Domestic Partnership
Paternity
Modification of Child or Spousal Support
Send it
