General Intake Form – Law Offices of Susan M. Buckholz

Once we have names of all parties, we will perform a conflict of interest check. Providing there is no conflict, we can move forward with scheduling a 1 hour consultation with Attorney Buckholz.
Attorney hourly rate is $350.00 and is expected the day of the meeting. Cash, Check or Credit Card is accepted.
Our office is located at 1856 Quechee Main Street, No. 1C, Quechee, VT 05059.
If any documents have been filed, we ask that they are brought to the first meeting or sent ahead of time.

Name *

First

Last

Phone *

Email *

Street Address *

City *

State *

Zip *

Other Party Name *

First

Last

Other Party Email *

Other Party Phone *

Other Party Street Address *

Other Party City *

Other Party State *

Other Party Zip *

Add'l Party Names

please separate names by using a semicolon EX: John Smith; Julia Smith; etc.

Name of Other Party's Attorney (if known)

Please briefly describe the reason you are seeking a consultation: *

Date of Marriage/Civil Union (MM/DD/YYYY)

(Fill out if you are enquiring about a Family Court Matter)

Date of Separation (MM/DD/YYYY)

(Fill out if you are enquiring about a Family Court Matter)

If action is filed, please provide name of court and docket number:

(Fill out if you are enquiring about a Family Court Matter)

Please list the names and dates of birth of minor children:

(Fill out if you are enquiring about a Family Court Matter) Please provide full name followed by a dash and then age, separate names using a semicolon EX: John Smith-12; Julia Smith-8; etc.

Other information you would like to know:

Preferred days/times for mediation:

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