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501-442-6300
Home
About
Services
Adoption
Estate Planning
Guardianship
Juvenile Law
Testimonials
501-442-6300
PATERNITY CLIENT INTAKE FORM
Full Legal Name
*
Date of Birth
*
MM
DD
YYYY
Phone Number
*
(###)
###
####
Email Address
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Name of Child 1
*
Child 1 Date of Birth
*
MM
DD
YYYY
Child 1 Place of Birth
*
(City and County)
Was your name listed on the birth certificate?
*
Yes
No
I don't know
Has a judge ever ordered child support for this child?
*
Yes
No
I don't know
If yes, please explain
Name of Child 2
Child 2 Date of Birth
MM
DD
YYYY
Child 2 Place of Birth
(City and County)
Was your name listed on the birth certificate?
Yes
No
I don't know
Has a judge ever ordered child support for this child?
Yes
No
I don't know
If yes, please explain
Name of Child 3
Child 3 Date of Birth
MM
DD
YYYY
Child 3 Place of Birth
(City and County)
Was your name listed on the birth certificate?
Yes
No
I don't know
Has a judge ever ordered child support for this child?
Yes
No
I don't know
If yes, please explain
Have you taken a DNA test?
*
Yes
No
If yes, for which child(ren)?
Mother's Full Name
*
Mother's Date of Birth
MM
DD
YYYY
Mother's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Do you suspect any illegal drug use by the child(ren)'s mother?
Yes
No
Would you like me to request that the judge order a drug screen for the mother?
If a drug test is requested, you will be required to pay for it.
Yes
No
If so, please explain
What type of custody/visitation are you seeking?
*
How much visitation are you currently getting with the child(ren)?
*
Frequent
Occasional
None
Do you have concerns about the child's living conditions or safety? (If the child is not currently living with you)
*
Yes
No
If so, please explain
Do you understand that by asking the Court to establish paternity and custody, the judge may also order you to pay child support — including back child support — even if you are seeking joint or full custody?
*
I understand I may be ordered to pay child support if I pursue this action.
Additional Information
Please provide any additional information you feel I need to know about your case.
Thank you!
