Intake Form – Harris Divorce Law

Potential Client Intake Form

Please fill out the entirety of the form below. Our office will run a conflict check and contact you to schedule a consultation. Please include all of your contact information so that we can reach you. Submission of this form does not establish an attorney-client relationship.

Name

Phone Number

Reason(s) for Contacting Harris Divorce & Family Law (please note: if you are not currently a client, you do not have attorney/client privilege through this form)

Street Address

Street Address 2

City State (Please note we are only available to help clients that currently reside in the state of Georgia)

Zip Code

County of Residence

If inquiring about Divorce, have both you and your spouse resided in this county for at least 6 months?

Name of Opposing Party

Address of Opposing Party

Opposing Party's County of Residence

Opposing Party's Email

Date of Marriage

Date of Separation

Has the Opposing Party retained an Attorney?

Maiden Name

Referred By

Potential Client Intake Form

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