Wallacker Family Law | Mediation & Consulting

Parentage

Collaborative or Consulting for Mediation

Confidential Initial Consultation Intake Form: Please complete all fields below that apply to you and your matter. This information will be used to run a conflict of interest check through our system and will be kept confidential. Not all fields will apply to your matter.

Step 1 of 3

Collaborative Practice or Consulting for Mediation?

Please indicate whether you are interested in speaking with Gretchen about Collaborative Practice or Consulting for Mediation.(Required)

Your Information

Full legal name(Required)
Current home address(Required)
Maiden name or any name(s) used from former relationships:
The name(s) of your former spouse(s):
First
Middle
Last
 
The name of your current spouse:
The name of your current fiancé:
The name(s) of your current spouse’s former spouse(s):
First
Middle
Last
 
The name(s) of your current fiancé’s former spouse(s):
First
Middle
Last
 
The names and ages of your children from other relationships:
First
Last
Age
 
If employed, the name of your company and job title:
Company
Job Title
 
If you previously had or are currently working with an attorney on this matter, please provide their name:
If you previously had or are currently working with a mediator on this matter, please provide their name (if you do not have a mediator, we can provide referrals):
The name(s) of who referred you to Gretchen: