Family Law Intake Questionnaire

How to Complete This Form

Answer every question to the best of your knowledge.
If a question does not apply to your situation, write "N/A."
If you are unsure of an answer, write "unsure" — do not guess.
Approximate dates are acceptable where exact dates are unknown.
You may attach additional pages or documents if needed.

1 Conflict Check & Your Information

Start here. This section lets the firm check for conflicts of interest before reviewing the rest of your matter. Please give the other party’s full name. Until the firm confirms it can represent you, do not include confidential strategy or settlement positions anywhere in this form.

Your Full Legal Name

Former / Maiden Names (if any)

Date of Birth

Preferred Contact Method

Email Address

Cell Phone

Any contact restrictions the firm should know (e.g., do not call at work, safe times)

Street Address

City

Parish

State

How long have you lived in this parish?

How long have you lived in Louisiana?

Other Party’s Full Legal Name (spouse, co-parent, or adverse party)

Other Party’s Former or Maiden Names (if any)

Anyone else the firm should run a conflicts check on (children’s other parent, family members, businesses involved)

I am contacting Aertker Legal, LLC in good faith to seek possible representation. I have identified the other party so the firm can check for conflicts, and I understand the firm cannot represent me if a conflict exists.

2 The Other Party

Basic facts about the other party help the firm assess jurisdiction, service, and support. Estimates are fine.

Other Party’s Date of Birth (if known)

Other Party’s Parish

Other Party’s Address (if known)

Other Party’s Employer

Is the other party represented by an attorney?

Other Party’s Attorney (if known)

Anything about the other party the firm should know (facts only — no strategy)

4 Existing Court Proceedings

Is there already a court case filed in this matter?

Yes No Not sure

Parish of the case

Court (e.g., 22nd JDC)

Docket Number (if known)

Division (if known)

Judge (if known)

Next court date (if any)

Existing orders in place (custody, support, protective, etc.) — list briefly

Are you currently represented by another attorney in this matter?

Yes No

Your current / former attorney

5 Marriage / Relationship

Your relationship to the other party

Date of Marriage

Place of Marriage

Parish where you last lived together as a couple

Property regime

Is this a covenant marriage?

Yes No Not sure

Grounds for covenant-marriage divorce/separation (if known)

Pre-marriage counseling completed?

Pre-divorce counseling completed?

Date you physically separated (if applicable)

Are you currently living together?

Yes No

Briefly, the circumstances of separation (who moved out, when) — facts only

Prior marriages (yours or the other party’s), if relevant

6 Grounds for Divorce (if applicable)

Facts only in this section — please do not include argument or strategy.

What kind of divorce are you considering?

Have you lived separate and apart for the required period (180 days without minor children; 365 days with minor children)?

Yes No Not sure

If fault-based, briefly state the factual basis (e.g., adultery, felony conviction). Facts only.

7 Children

Do you and the other party have children together (or children at issue)?

Yes No

List each child below. If there are more than three, use the “additional children” box.

Child 1 — Name

Date of Birth

Currently lives with

School / grade

Any special needs for this child

Child 2 — Name

Date of Birth

Currently lives with

School / grade

Any special needs for this child

Child 3 — Name

Date of Birth

Currently lives with

School / grade

Any special needs for this child

Additional children (4 or more) — names and dates of birth

Current custody / visitation arrangement (formal or informal)

What custody arrangement are you seeking?

Paternity (if relevant)

Anything more about your custody goals (optional)

Any safety, schooling, or special-needs concerns about the children

Children from other relationships (yours or the other party’s), if relevant

Is relocation an issue?

Relocation details

8 Child Support

Is there an existing child-support order?

Yes No

Current monthly amount

Your gross monthly income

Source of your income

Other party’s gross monthly income (estimate)

Number of children at issue

Who provides the children’s health insurance / monthly cost

Work-related childcare cost (monthly)

Extraordinary medical or special expenses (monthly)

Support you pay for other children

9 Spousal Support

Spousal support

Interim (during the case) support at issue?

Yes No

Final (post-divorce) support at issue?

Yes No

Your approximate monthly living expenses / needs

Standard of living during the marriage (briefly)

Any facts relevant to fault that may affect final support (facts only)

10 Community Property — Assets & Debts

A high-level snapshot is fine here — a detailed inventory comes later, after representation is confirmed.

Do you and/or the other party own real estate?

Yes No

The family home

Approximate value of the home

Approximate mortgage balance

Other real estate (addresses, rough value)

Bank, investment, and retirement accounts (institution and rough value)

Business interests or professional practices

Vehicles and other significant property

Do you claim any separate property (inherited, owned before marriage, donated to you alone)?

Describe the separate property you claim

Has the other party hidden, transferred, or wasted any assets? (facts only)

Significant debts (mortgages, loans, credit cards)

11 Safety & Protective Orders

If you are in immediate danger, call 911. For confidential help, the Louisiana statewide domestic violence hotline is available 24/7.

Has there been domestic abuse or family violence in this relationship?

Yes No Prefer not to say

How safe do you feel right now?

Is there an existing protective order or restraining order (in either direction)?

Yes No

Briefly describe (who, which court, current status)

Has law enforcement been involved? List any report numbers or dates.

Do you have immediate safety concerns?

Yes No

12 Other Information

These questions help the firm spot issues that affect strategy. Skip any that do not apply.

Is anyone pregnant?

Pregnancy details (due date, etc.)

Military connection?

Military details (branch, station)

Any bankruptcy history?

Bankruptcy details

Any DCFS / child-protection involvement?

DCFS details

Any prior mediation or counseling?

Mediation / counseling details

Do you want a former name restored?

Name to restore

13 Goals & Additional Information

In a sentence or two, what outcome are you hoping for?

Any upcoming hearings, deadlines, or time-sensitive issues

Anything else the firm should know (please avoid confidential strategy until representation is confirmed)

How did you hear about the firm?

14 Acknowledgment

I certify that the information provided in this questionnaire is true, accurate, and complete to the best of my knowledge. I understand that this questionnaire does not create an attorney-client relationship, and that no legal advice has been provided. I have read and understand the confidentiality notice above. I authorize Aertker Legal, LLC to contact me regarding my inquiry and to gather additional information as necessary to evaluate my claim. I understand that I should not delete, alter, or post about this incident on social media, and that I should preserve all evidence related to this matter — including photographs, videos, text messages, the product involved (if applicable), and any physical evidence — in its current condition.

Printed Name

Signature

Or type your name to sign:

Date

Supporting Documents (optional)

Attach up to three documents relevant to your matter — for example an existing will, deed, contract, police report, or correspondence. PDF, Word, or image. You may bring or email additional documents to your consultation.

Maximum ~10 MB. For larger or highly sensitive files, please bring them to your appointment.

How to Complete This Form

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