Is the client currently represented by an attorney? If yes, what is the name of the attorney?
Safe Mailing Address (CL)
City (CL)
State (CL)
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico
Zipcode (CL)
Court County
Barnstable Berkshire Bristol Dukes Essex Franklin Hampden Hampshire Middlesex Nantucket Norfolk Plymouth Suffolk Worcester
Safe to leave message
Race (CL)
African American/Black Native American/Alaskan Native Asian Bi-racial Native Hawaiian/Pacific Islander Hispanic/Latino Caucasian/White Other
Preferred Language (CL)
Have you resided in Massachusetts for at least a year?
US Citizen? (CL)
If not a US citizen, explain (CL)
Do you have children?
Child 1 Name
Child 1 DOB
Child of OP? (Child 1)
Child 2 Name
Child 2 DOB
Child of OP? (Child 2)
Child 3 Name
Child 3 DOB
Child of OP? (Child 3)
Children notes
Currently employed? (CL)
If not currently employed, prior occupation (CL)
Employer (CL)
Occupation (CL)
Client Current Income
Is your income weekly, biweekly, monthly, or yearly?
Weekly Biweekly Monthly Yearly
Client Current Income (Annualized)
Do you have any other income?
Other Income (TAFDC)
Other Income (SSI)
Other Income (SSDI)
Other Income (Alimony)
Other Income (Child Support)
Other Income (Rental Income)
Other Income (Other)
Is your Total Other Income weekly, biweekly, monthly, or yearly?
Weekly Biweekly Monthly Yearly
Total Other Income (Annualized)
Family Size
Is there a marital home?
When was it bought?
Opposing Party Name
Address (Main) (OP)
Date of Birth (OP)
Language (OP)
US Citizen? (OP)
If not a US citizen, explain (OP)
Living with OP now?
Have you lived with OP previously?
Were you married?
Where were you married?
Marriage date
Separation date
Divorce date
Have you experienced domestic abuse in your relationship?
Do you have an upcoming court date?
What is your docket number?
Hearing Format
In person Telephonic Zoom
Hearing Dial-In Number or Zoom Link
Are you calling for help on a restraining order?
Do you already have a restraining order?
Issuing court and Expiration Date
Has DCF ever been involved or are they currently involved?
Pronouns
She/her/hers He/him/his They/them/theirs Not listed here Prefer Not to Say
How much is the monthly mortgage payment?
How much equity in the home?
OP Pronouns
She/her/hers He/him/his They/them/theirs Not listed here
