Coe Law Offices
150 Howard Lane
P.O. Box 1329
Fayetteville, Georgia 30214
Tel: 770-719-9363
Fax: 770-719-9310
Web: www.philipcoelaw.com
Email:pscoe@bellsouth.net

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Divorce/Family Law Inquiry Form

In order to contact Mr. Coe regarding divorce or other family law issues (custody disputes, contempt actions, actions to modify child support, alimony or visitation, paternity actions, legitimation) in or related to Georgia, you may submit the following inquiry form. We will preserve the confidentiality of any information you provide to the full extent provided by the Georgia Code of Professional Responsibility. Form submissions are relayed to us through a third-party form response processing provider with a strict privacy policy. As you may know, however, no unencrypted internet communication is totally guaranteed to be secure. If you prefer, you may contact us by mail, fax or telephone, as indicated above.

PLEASE NOTE THAT CONTACTING MR. COE VIA THIS RESPONSE FORM, OR OTHERWISE, DOES NOT CREATE AN ATTORNEY-CLIENT RELATIONSHIP. If. after reviewing the information you submit, Mr. Coe feels he may be able to help, you will be contacted regarding the scheduling of an initial office consultation. Mr. Coe does charge for such consultations, generally at the rate of $250 per hour. If Mr. Coe does ultimately accept your case, you will need to arrange to make a retainer deposit to apply toward future work on your case. For more details regarding these matters, click on "Fees" in the menu bar above.

Use the tab key or the mouse to advance from one field to another. Do not hit "return" key until you are ready to transmit the form.
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Information About Who You Are and How We Can Reach You:

First Name
Last Name
Number, Street & Apt.
City
State
Zip
Day Telephone
Night Telephone
E-mail (Email address required for a response.)

Tell Us About the Person Who Needs Advice Or Representation:

Sometimes the person contacting a lawyer is doing so on behalf of someone else, such as a parent or sibling on behalf of another family member, or a friend, acquaintance or co-worker attempting to assist someone else in obtaining counsel. Please provide the following information on behalf of person who needs assistance.

The following information is for myself: Yes No

If "no," my relationship to the following person is:

Prospective Client's First Name
Last Name
Client's Age
Client's Gender: Male Female

Client's Occupation
How long engaged in this type of work?
What are the prospective client's approximate earnings per month?
Name and address of current or last employer
Highest grade or degree completed
Special training, certifications or experience:

Nature Of The Problem:

Please provide a brief summary of the nature of the problem and what legal help you feel is needed. (200 words or less)

Information Regarding The Marriage, if applicable, and the Spouse, Former Spouse or Partner:

Name of Spouse (or Former Spouse) or Partner:

First Name
Last Name
Spouse or Partner's Age
Spouse or Partner's Gender: Male Female

Date and place of marriage:

Are the parties separated?: Yes No

If "yes," describe the parties' current living arrangements and provide the spouse's/partner's present address, if known:

Spouse or Partner's Occupation
How long engaged in this type of work?
What are spouse/partner's approximate earnings per month?
Name and address of current or last employer of spouse/partner
Highest grade or degree completed by spouse or partner
Special training, certifications or experience:

Information Regarding Children:

List the names, ages and birthdates (MM-DD-YYYY)and gender of all children of the marriage. Please also state where the children currently reside (i.e., with father, mother, both or other).

Do either of the parties have other children by a prior marriage or relationship? If so, state their names, ages, whose child they are, where they live and whether either party is paying or receiving support for them.

Is There Any Past Or Threatened Family Violence?

Describe any past or threatened family violence or abuse toward either spouse or children. State whether you feel immediate relief must be sought to prevent further violence or abuse and the basis for such belief.:

What Property Issues Are Involved?

Describe the nature and value of any major items of property that may be at issue, including real estate, bank accounts or savings, investments, stocks, bonds, pensions plans or retirement accounts, collectibles, and the like. :

Is there anything else we should know?

Please provide any additional information that you feel is relevant or which you feel we may need to know in order to evaluate the situation:

When is the best time to reach you by telephone?

If the information you have provided is complete, please press the Send button below to send it to the Philip S. Coe Law Offices. Your information will be kept confidential.




© 2005, Philip S. Coe

This web site is designed for general information only. The information presented at this site should not be construed to be formal legal advice nor the formation of a lawyer/client relationship.