New Client Intake
Date
Legal First Name
Legal Middle Name
Legal Last Name
Name you want to legally change to (if applicable)
Best Number To Contact
Secondary Phone Number
Email Address
Mailing Address
City of Mailing Address
State of Mailing Address
(Abbreviation, ex: "CO")
Zip Code of Mailing Address
Physical Address (if different than above)
City of Physical Address
State of Physical Address
(Abbreviation, ex: "CO")
Zip Code of Physical Address
Date of Birth
Social Security Number
xxx-xxx-xxxx
Place of Employment
Annual Income
What County Do You Live In
*
Please Select One
Larimer County, Colorado
Weld County, Colorado
Which Issues Needs To Be Addressed? Check All That Apply
Separation / Divorce / Annulment
Mediation
Allocation of Parental Responsibilities
Child Custody and/or Visitation
Child Support
Proper Division
Alimony / Spousal Support
Modification of Prior Court Order
Enforcement of Prior Court Order
Stepparent Adoption
Are You Military?
Yes
No
Date Married (if applicable)
Place of Marriage
Date Physically Separated
Date of Divorce or Date of Your Allocation of Parental Responsibilities Case
Length of Time (yrs/mos) that you have been in Colorado
Are there any protection orders in place?
Yes
No
Are there any other Court proceedings that could affect this case?
Yes
No
Are any of the parties or children receiving government assistance?
Yes
No
Case Number
Spouse / Former Spouse / Co-Parent Information
Legal First Name of Spouse / Former Spouse / Co-Parent
Legal Middle Name of Spouse / Former Spouse / Co-Parent
Legal Last Name of Spouse / Former Spouse / Co-Parent
Are you Still Living Together?
Yes
No
Spouse / Former Spouse / Co-Parent Phone Number
Secondary Phone Number (if applicable)
Spouse / Former Spouse / Co-Parent Email Address
Mailing Address of Spouse / Former Spouse / Co-Parent
City of Mailing Address of Spouse / Former Spouse / Co-Parent
State of Mailing Address of Spouse / Former Spouse / Co-Parent
(Abbreviation, ex: "CO")
Zip Code of Mailing Address of Spouse / Former Spouse / Co-Parent
Physical Address of Spouse / Former Spouse / Co-Parent
City of Physical Address of Spouse / Former Spouse / Co-Parent
State of Physical Address of Spouse / Former Spouse / Co-Parent
(Abbreviation, ex: "CO")
Zip Code of Physical Address of Spouse / Former Spouse / Co-Parent
Length of Time (yrs/mos) that of Spouse / Former Spouse / Co-Parent have been in Colorado
Date of Birth of Spouse / Former Spouse / Co-Parent
Social Security Number of Spouse / Former Spouse / Co-Parent
xxx-xxx-xxxx
Place of Employment of Spouse / Former Spouse / Co-Parent
Annual Income of Spouse / Former Spouse / Co-Parent
Is Your Spouse / Former Spouse / Co-Parent in the Military?
Yes
No
Do You Have Minor Children?
Yes
No
Legal First Name of Child 1
Legal Last Name of Child 1
Gender of Child 1
Male
Female
Primary Address of Child 1
City of Primary Address of Child 1
State of Primary Address of Child 1
(Abbreviation, ex: "CO")
Zip Code of Primary Address of Child 1
Date of Birth of Child 1
Social Security Number of Child 1
xxx-xxx-xxxx
Legal First Name of Child 2
Legal Last Name of Child 2
Gender of Child 2
Male
Female
Primary Address of Child 2
City of Primary Address of Child 2
State of Primary Address of Child 2
(Abbreviation, ex: "CO")
Zip Code of Primary Address of Child 2
Date of Birth of Child 2
Social Security Number of Child 2
xxx-xxx-xxxx
Legal First Name of Child 3
Legal Last Name of Child 3
Gender of Child 3
Male
Female
Primary Address of Child 3
City of Primary Address of Child 3
State of Primary Address of Child 3
(Abbreviation, ex: "CO")
Zip Code of Primary Address of Child 3
Date of Birth of Child 3
Social Security Number of Child 3
xxx-xxx-xxxx
Legal First Name of Child 4
Legal Last Name of Child 4
Gender of Child 4
Male
Female
Primary Address of Child 4
City of Primary Address of Child 4
State of Primary Address of Child 4
(Abbreviation, ex: "CO")
Date of Birth of Child 4
Zip Code of Primary Address of Child 4
Social Security Number of Child 4
xxx-xxx-xxxx
Legal First Name of Child 5
Legal Last Name of Child 5
Gender of Child 5
Male
Female
Primary Address of Child 5
City of Primary Address of Child 5
State of Primary Address of Child 5
(Abbreviation, ex: "CO")
Zip Code of Primary Address of Child 5
Date of Birth of Child 5
Social Security Number of Child 5
xxx-xxx-xxxx