* In which of the following Counties will your case be filed?

Harris
Brazoria
Galveston
Chambers
Montgomery
Fort Bend
Other

What is your marital status?

How many children do you have?

Do you own a home?

Yes
No

Do you have any other assets?

Yes
No

Do you work?

Yes
No

What type of services are needed (check all that apply)?

Child Custody
Child Support
Divorce
Domestic Violence
Spousal Support
Visitation Rights
Adoption
Other

Please describe your situation:

* If your case is accepted, are you willing to pay a minimum retainer of $2500.00 for professional services rendered?

YES

* What is the best method for the attorney to contact you?

Telephone
E-mail

If by telephone, what is the best time for the Attorney to contact you?


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