Initial Consult Form | Fairfax Family Law Attorneys, Virginia Divorce Lawyers

Initial Consult Form

Fairfax Family Law Attorneys

For an initial consultation with an experienced attorney at Cooper Ginsberg Gray regarding your case, please submit the following response form. We will respect the confidentiality of your information to the fullest extent. Form submissions are relayed to us through our highly secure servers.

Tell us who you are and how we can contact you. Note: This information is strictly confidential and will not be communicated with anyone. It is necessary only for purposes of enabling us to do a conflict of interest check prior to responding to you. We cannot respond without being able to do our conflict check. Bold Fields are required.

Potential New Client Information

The following information is for myself:

Yes No

If “No” please fill in the following information:

Full Name

Phone

Client Full Name

Client Maiden Name (if applicable)

Client Home Street Address and Apt No.

Client Home City

Client Home State

Client Home Zip

Client E-mail

Best Number to be reached at

Secondary Number to be reached at

OK to leave VM at this number?

Yes No

Spouse/Opposing Party Information

Full Name*

Maiden Name(if applicable)

Case Information

County

Name of Childern (and ages if any)

Date of Seperation

Date of Divorce

Any Court Filings

Spouse Attorney (if known)

Comes From

Reffered by Specific

Attorney preference

Specific Attorney

Choices

Gender

Budget

Any other information

Please provide us with a very brief overview, in 200 words or less, describing in general the subject matter of your request:

When the information you have provided is complete, please press the Submit button below to send it to our firm. Your information will be kept strictly confidential.