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New Client Information – Family Case Form
Name
(Required)
First
Last
Mainden Name
Date
MM slash DD slash YYYY
Home Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Email
(Required)
Home Phone
Cell Phone
Work Phone
Social Security Number
State of birth
Birth date
MM slash DD slash YYYY
How long in Illinois
May we contact you at home?
Yes
No
Alternate Number
What is the best way to communicate with you?
Mail
Email
Phone
Employed by
Occupation
Work Address
Date of Hire
MM slash DD slash YYYY
Gross Pay
Net Pay
Married or Cohabitating?
Children and Child Support Information
Name
DOB
MM slash DD slash YYYY
School/Grade
Does either party, including your children, have any special physical or mental health problems?
Yes
No
If so, describe
Are you paying or receiving child support at this time?
Yes
No
In what amount
Child’s Natural Mother
(Skip if you are named above):
Legal Name
First
Last
Maiden name
Home Address
Street Address
City
State / Province / Region
ZIP / Postal Code
E-mail
Home Phone
Birthdate
MM slash DD slash YYYY
State of birth
How long in Illinois
Work Phone
May we contact them?
Yes
No
Cell Phone
Employed by
Occupation
Work Address
Date of Hire
MM slash DD slash YYYY
Gross Pay
Net Pay
Married?
Child’s Natural Father
(Skip if you are named on page one):
Name
First
Last
Home Address
Street Address
City
State / Province / Region
ZIP / Postal Code
E-mail
Home Phone
Birthdate
MM slash DD slash YYYY
State of birth
How long in Illinois
Work Phone
May we contact at home?
Yes
No
If not, provide alternate number
Cell Phone
Employed by
Occupation
Work Address
Date of Hire
MM slash DD slash YYYY
Gross Pay
Net Pay
Married?
Is Parentage Established by Court Order?
Yes
No
Name on Birth Certificate
DNA Test Results
Case, Court & Legal Background Information
Opposing Attorney(s)
Guardian Ad Litem Appointed?
Yes
No
Case filed in Court?
Yes
No
Case No.
County
Court Date
MM slash DD slash YYYY
Court Time
Hours
:
Minutes
AM
PM
AM/PM
IS DCFS involved?
Yes
No
Caseworker
Does any party have a criminal record?
Yes
No
If so, what party?
What Criminal History (Offense and County)?
Is any party a registered sex offender?
Yes
No
If so, what party?
Does any party have DCFS Indicated findings of abuse or neglect or court findings of Unfitness?
Yes
No
If so, what party?
Physical Description of Opposing Party
Height
Weight
Hair Color
Distinguishing features
Assets of Both Parties
Marital Residence
Estimated value
Debt
Other Real Estate
Estimated value
Debt
Vehicle
Estimated value
Debt
Other
Estimated value
Debt
Pensions/IRAs
Estimated value
Debt
Checking/Savings
Estimated value
Indebtedness of Both Parties
To whom
Amount
Referral Information
Who Referred You To Our Office (or how did you hear about us):
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