Client Intake

Confidential Client Initial Consultation Information Sheet

This Form is Fully Encrypted for Your Security.

If you do not feel comfortable transmitting this information electronically, you are welcome to download the form below and deliver it to our offices in person.

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Your Information

Your Name: (Required)

Your Email: (Required)

Your Street Address: (Required)

Would You Prefer to Receive Your Mail via Email?

Your Cell Number:

Your Home Number:

Your Work Number:

Your Fax Number:

Your Date of Birth:

How Long Have You Lived in Colorado?

Social Security Number:

Employer:

Employer Address:

Type of Work:

Income:

Child's Name:

Child's Date of Birth:

Child's SSN:

Child's Name:

Child's Date of Birth:

Child's SSN:

Child's Name:

Child's Date of Birth:

Child's SSN:

Date of Marriage:

Place of Marriage:

Date of Separation:

Adverse Party Information

Adverse Party Name: (Required)

Adverse Party Email:

Adverse Street Address: (Required)

Adverse Party Cell Number:

Adverse Party Home Number:

Adverse Party Work Number:

Adverse Party Fax Number:

Adverse Party Date of Birth:

How Long Have They Lived in Colorado?

Adverse Party Social Security Number:

Employer:

Employer Address:

Type of Work:

Income:

Attorney Name:

Attorney Address:

Attorney Phone #:

Attorney's Fax #:

Summary of Dispute (i.e. Divorce, Child Custody, Child Support, etc.):

Have you had prior representation by an attorney in this or a related matter?

If yes, what was the Attorney’s name?

Has this firm represented anyone you know?

If yes, who is that person?

In an effort to track our marketing efforts, please tell us which attorney(s) you were referred to:

If someone referred you to our firm, please tell us their name (and address, if possible) so that we may thank them for the referral.

By Clicking "Send" You Acknowledge the Following:
CONSULTATION FEE: I understand and agree that domestic relations consultations at CAGE BUCAR LEWIS, LLC. are not free. I agree to pay the consultation fee. Payment is to be made at the end of the session.

NO REPRESENTATION: I agree I have not retained the firm of CAGE BUCAR LEWIS, LLC for any purpose unless set forth in a written retainer agreement, or agreed to in writing by CAGE BUCAR LEWIS, LLC.