Canova Law & Mediation

217 E. Dickson St. Suite 106H (Top floor)
Fayetteville, AR 72701-4283

(479) 442-5800

General Intake

Any information provided herein is subject to attorney client confidentiality and shall not be disclosed without your consent. Your submission of this Intake does not create an attorney-client relationship and no action shall be taken by Canova Law & Mediation on your behalf until an Attorney-Client Agreement has been signed.

Today's Date:

CLIENT INFORMATION

Contact information

Prefix

First name *

Middle name

Last name *

Emails

Address *

Type

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

PrimaryDefault email false

Addresses

Street address

Country

City

State/Region

Province/Region

Zip/Postal code

Address type

PrimaryDefault address false

Phone numbers

Phone number

Type

Primary

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County in which you reside:

May we send you text messages?

Yes

No

CASE INFORMATION

Other Case Details:

Date of Marriage:

if applicable

What may we help you with?

MediationDivorcePaternityCustody of ChildrenChild SupportGuardianship of a MinorContemptOtherAdoptionGrandparent Visitation

Date of Separation:

if applicable

OPPOSING PARTY INFORMATION

First Name of Opposing Party:

Middle Name fo Opposing Party:

Last Name of Opposing Party:

Residential Undefined Mailing Address of Opposing Party:

In what county does the opposing party reside?

Are there children involved?

Yes

Names and Dates of Birth:

No

Has a lawsuit been filed?

Yes

In what county was it filed?

No

Not Sure

Are you currently represented by an attorney?

Yes

Who?

No

Is the opposing party represented by an attorney?

Yes

Who?

No

Unknown

How did you hear about us?

THANK YOU

When you are finished, please click the "Submit" button.