3675 Crestwood Parkway, Suite 400

Duluth, GA 30096

Phone: 678-306-6381

Natalie@NataliePhanLaw.com

Thank you so much for contacting our law office! Please read the privacy policy below, and then fill out this form in its entirety to help us determine whether we can provide the services you have requested.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 128-bit SSL encryption.

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!

PART 1: INFORMATION ABOUT YOU

_______________________________________________________

Contact information: Your Contact Information

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

- Are you currently living at the address above?

Yes

- What is your marital status?

Married

Divorced

Widowed

Other

What is the best method to contact you?

When is the best time to contact you?

- Do you have any minor children (under 18 years old) with the opposing party?

Yes

- Are you (or your partner) currently expecting a new born child?

Yes

- Do you have any safety concerns? Example: Incidents involving violence or abuse.

Yes

PART 2: INFORMATION ABOUT THE OPPOSING PARTY

Parties may be adverse to one another on some issues and in agreement on other matters. For the purpose of this form, the opposing party is the person whose interests are in conflict with yours. The opposing party is either your spouse, ex-spouse, or the parent of your children.

Why we need this information? Natalie Phan Law has a legal duty to protect the interests of our current clients, former clients, and all prospective clients. Before you disclose any sensitive information to us, we must make sure that we have never represented your opposing party in any other matters (conflict check), which may or may not be related to the current legal help you are seeking.

Our office will ONLY use the information you provided regarding the opposing party for the purpose of performing a conflict check.

Contact information: Contact Information of Opposing Party

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

- Is the opposing party currently living at the address above?

Yes

PART 3: REQUESTS FOR LEGAL SERVICES

_______________________________________________________

- Is there an upcoming court date or deadline for you?

Yes

- If you are seeking a modification (changes) of a previous court order, which court issued the last court order? (ie. Gwinnett Superior Court). SKIP this question if not applicable.

- How did you hear about our law firm?

If you are not sure, choose the last option, Other (not listed above).

- If you are seeking a modification (changes) of a previous court order, when was the order issued? SKIP this question if not applicable.

THANK YOU

NOTICE: By clicking the submit button, you acknowledge that you have read and hereby accept the above privacy policy regarding the use of your personal information. You acknowledge that this form does not create or constitute an attorney-client relationship with Natalie Phan Law, LLC.

Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We will contact you as soon as possible with any updates.

Please click the SUBMIT button below when you have finished answering all questions.

PART 1: INFORMATION ABOUT YOU

Contact information: Your Contact Information

- Are you currently living at the address above?

- What is your marital status?

What is the best method to contact you?

When is the best time to contact you?

- Do you have any minor children (under 18 years old) with the opposing party?

- Are you (or your partner) currently expecting a new born child?

- Do you have any safety concerns? Example: Incidents involving violence or abuse.

PART 2: INFORMATION ABOUT THE OPPOSING PARTY

Contact information: Contact Information of Opposing Party

- Is the opposing party currently living at the address above?

PART 3: REQUESTS FOR LEGAL SERVICES

- Check all of the issues that you want to discuss

- Is there an upcoming court date or deadline for you?

- If you are seeking a modification (changes) of a previous court order, which court issued the last court order? (ie. Gwinnett Superior Court). SKIP this question if not applicable.

- How did you hear about our law firm?

- If you are seeking a modification (changes) of a previous court order, when was the order issued? SKIP this question if not applicable.

THANK YOU