Step 2 of 3

Consultation Application

Step 2 of 3

Thank you. Our office has reviewed your initial information, and you can now complete the consultation application. This form helps us understand your situation before we meet so we can use your consultation time well.

Here’s what happens next:

Complete and submit the application below..
Schedule your consultation.

After this application is complete, you’ll move to the final step where you can schedule your consultation and pay the $250 consultation fee.

Application

Have you been notified by us that you have passed a conflicts check?

Have you been notified by us that you have passed a conflicts check?

Yes No

Your Personal Information:

First Name

Middle Name

Last Name

Address

Phone

Date of Birth

Social Security #

Employer & Occupation

Spouse’s Personal Information:

First Name

Middle Name

Last Name

Address

Phone

Date of Birth

Social Security #

Employer & Occupation

Marriage Statistics

Are You or Your spouse Active Duty Military?

Are You or Your spouse Active Duty Military?

Yes No

Date of Marriage (MM/DD/YY)

How long lived in Florida?

Wife’s Maiden or Former Name

Location of Marriage (city, county, state)

Will the Wife’s married name be changed back to maiden or former name?

Will the Wife’s married name be changed back to maiden or former name?

Yes No

Children

Do you have children?

Do you have children?

Yes No

List all children born or adopted during the marriage. Include adult children for vital statistics purposes.

Full Name:

Date of Birth (MM/DD/YY)

City & State of Birth

SSN#

Full Name:

Date of Birth (MM/DD/YY)

City & State of Birth

SSN#

Full Name:

Date of Birth (MM/DD/YY)

City & State of Birth

SSN#

Full Name:

Date of Birth (MM/DD/YY)

City & State of Birth

SSN#

Full Name:

Date of Birth (MM/DD/YY)

City & State of Birth

SSN#

Children’s Addresses

List the address where each child has lived for the last 5 years:

Dates (From/To)

Address (City & State)