Personal Service Individual Attention

call (760) 643.4114
380 South Melrose Drive, Suite 401
Vista, CA 92081

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Home
About The Firm
- About Our Locations
- Intake Form
Attorney
- Paula D. Kleinman
Practice Areas
Blog
Contact

Intake Form

All Information Below is CONFIDENTIAL

Step 1 of 8

12%

Today's Date
MM slash DD slash YYYY
ABOUT YOU
Your Name
Address
Home Address City State Zip Code
Home Phone
Work Phone
Cell Phone
Email
Date of Birth
MM slash DD slash YYYY
Social Security #
Current Occupation/Job Title
Current Employer
Address
Employer's Address City State Zip Code
Gross Monthly Income
Date you began this job
MM slash DD slash YYYY
If not currently employed, when did you last work?
Previous Employer's name and address
What was your annual gross income from that job?
What is your education level? (Years completed/degrees obtained)
Type Of Case
Stage Of Your Case

ABOUT THE OPPOSING PARTY
Their Name
Address
Their Home Address City State Zip Code
Home Phone
Work Phone
Cell Phone
Email
Birth Date
MM slash DD slash YYYY
Social Security #
Current Occupation/Job Title
Current Employer
Address
Employer's Address
Gross Monthly Income
Date they began this job
MM slash DD slash YYYY
If not currently employed, when did you last work?
Previous Employer's name and address
What was their annual gross income from that job?
What is their education level? (Years completed/degrees obtained)
Opposing Party's Attorney (If Known)
Case Number (if any)

MARRIAGE HISTORY (If applicable)
Date and Place of Marriage
Are you still living together?
If not, when did you separate?

PENSION PLANS
Are there or has there been any Pensions/Retirement Plans?
If yes, please list

CHILDREN
Please list all children from this relationship (Please list names and dates of birth)
With whom are the children now living?

HOW DID YOU HEAR ABOUT THIS OFFICE?
Personal
- Personal
Referral by
INTERNET:
- VistaFamilyLawyer
- Lawyer.com
- FindLaw.com
- Avvo
- Facebook
- Other
Other
if you used a search engine, what phrase did you search that led you to us?
What did you like about our ad?

YOUR CASE
Is there a current case?
- Yes
- No
If yes, what county is the case located in?
If no, what county do you plan on filing in?
Type of case? (Divorce/Dissolution of Marriage, Petition to Establish Parental Relationship/Paternity Action, DCSS Case/Child Support, Restraining Order)
Regarding stage of your case: (New Filing, Filed Documents, Prior to Judgment, Post-Judgment?)

WHAT WOULD YOU LIKE US TO DO FOR YOU?
WHAT WOULD YOU LIKE US TO DO FOR YOU?
PLEASE UNDERSTAND THAT I AM NOT YOUR ATTORNEY UNTIL SUCH TIME AS I HAVE RECEIVED A SIGNED CONTRACT, RETAINER FEE AND ANY COURT FEES NECESSARY FOR YOUR CASE.

I UNDERSTAND THAT THE ADVICES, INFORMATION OR RECOMMENDATIONS MADE BY ATTORNEY KLEINMAN AND ASSOCIATES ARE ONLY AS VALID AS THE COMPLETE AND TRUTHFUL INFORMATION I SUPPLY. I AM ALSO AWARE THAT I AM RECEIVING A FREE ONE-HALF HOUR CONSULTATION AND THAT ANY ADDITIONAL TIME TODAY OR IN THE FUTURE (INCLUDING TELEPHONE CALLS) WILL BE BILLED OR WILL REQUIRE A SIGNED ATTORNEY/CLIENT CONTRACT.

I DECLARE UNDER PENALTY OF PERJURY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
DATE:
MM slash DD slash YYYY
SIGNATURE:
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380 South Melrose Drive,
Suite 401
Vista, CA 92081

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