WEST PALM BEACH, FLORIDA (561) 847-4061
LAW OFFICES OFLyem Piña, P.A.Request a Consultation
CLIENT FORMS

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Auto Accident / Personal Injury

Incident Information Sheet

Client, emergency contacts, accident details, police report, injuries, vehicles, insurance and loss of earnings.

About 20 min · 12 sections
Questionnaire sections
  1. Client information
  2. Emergency contact & minor clients
  3. Accident information
  4. Passengers / companions — person 1
  5. Passengers / companions — person 2
  6. Property damage (your vehicle)
  7. Your automobile insurance
  8. Defendant (other driver) information
  9. Your injuries
  10. Loss of earnings & health insurance
  11. Prior accidents & referral
  12. Review & electronic signature
Complete online Original packet (PDF) — Incident Information Sheet; opens in a new tab

Family Law

Divorce Intake Questionnaire

Personal and spouse information, marriage history, children, employment, prior marriages, proceedings and other matters.

About 25 min · 9 sections
Questionnaire sections
  1. I. Your personal information
  2. II. Information about spouse
  3. III. History of this marriage
  4. IV. Your children
  5. V. Your employment
  6. VI. Your spouse’s employment
  7. VII–IX. Prior marriages, proceedings & reconciliation
  8. X. Other — property, debts & accounts
  9. Review & electronic signature
Complete online Original packet (PDF) — Divorce Intake Questionnaire; opens in a new tab

New Client Questionnaire – Florida Paternity Case

Client and opposing party, relationship history, child, custody, support, prior cases and documents.

About 15 min · 10 sections
Questionnaire sections
  1. 1. Client information
  2. 2. Opposing party (alleged mother / father)
  3. 3. Relationship history
  4. 4. Child information
  5. 5. Custody & timesharing
  6. 6. Child support
  7. 7. Prior court or agency involvement
  8. 8. Additional information
  9. 9. Documentation checklist
  10. Review & electronic signature
Complete online Original packet (PDF) — New Client Questionnaire – Florida Paternity Case; opens in a new tab

Estate Planning

Guardianship Client Questionnaire

Alleged incapacitated person, physician, proposed guardians, nearest relatives, monthly income and assets / liabilities.

About 20 min · 8 sections
Questionnaire sections
  1. Your contact information
  2. Alleged disabled person & physician
  3. Proposed guardian
  4. Co-guardian (if proposing a co-guardianship)
  5. Nearest living relatives
  6. Monthly income of disabled person
  7. Assets / liabilities
  8. Review & electronic signature
Complete online Original packet (PDF) — Guardianship Client Questionnaire; opens in a new tab

Estate Planning Packet / Paquete de Planificación Patrimonial

Revocable Living Trust, Pour-Over Will, Health Care Surrogate, Power of Attorney, Living Will — English / Español.

About 25 min · 8 sections
Questionnaire sections
  1. Personal Information / Información Personal
  2. Family Information / Información Familiar
  3. Goals & Concerns / Objetivos y Preocupaciones
  4. Trust & Will Provisions / Fideicomiso y Testamento
  5. Health Care & Financial Decisions / Decisiones Médicas y Financieras
  6. Assets / Activos
  7. Debts & Existing Documents / Deudas y Documentos
  8. Review & electronic signature
Complete online Original packet (PDF) — Estate Planning Packet / Paquete de Planificación Patrimonial; opens in a new tab

Real Estate Services

Florida Land Trust Planning Questionnaire

Owners, property and title, homestead and taxes, financing, proposed trustees and beneficiaries, objectives and records.

About 30 min · 9 sections
Questionnaire sections
  1. 1. Prospective client and current owners
  2. 2. Property and chain of title
  3. 3. Homestead, taxes, and property operations
  4. 4. Financing, liens, and title matters
  5. 5. Proposed trust structure and parties
  6. 6. Objectives and proposed operating terms
  7. 7. Related legal, tax, and financial considerations
  8. 8. Records to provide
  9. Review & electronic signature
Complete online Original packet (PDF) — Florida Land Trust Planning Questionnaire; opens in a new tab

Bankruptcy

Bankruptcy Questionnaire

Full financial intake: household, income, taxes, debts, creditors, lawsuits, transfers, property and monthly budget.

About 60 min · 18 sections
Questionnaire sections
  1. 1. Name and residence
  2. 2–3. Prior bankruptcies
  3. 4. Occupation and income
  4. 5. Taxes
  5. 6. Debts repaid
  6. 7–8. Suits, garnishment & sheriff’s sales
  7. 9–12. Repossessions, property held by others, transfers & losses
  8. 13–18. Attorneys, counselors, accounts & leases
  9. 19–21. Support, accidents & cosigners
  10. 22–23. Credit cards, payday loans & evictions
  11. 24. Secured debts
  12. 25. Unsecured debts & creditors
  13. 26A–B. Real property
  14. 26C–D. Personal property & vehicles
  15. 26E. Other property
  16. 27A–N. Budget — income & household
  17. 27O–S. Monthly expenses
  18. Review & electronic signature
Complete online Original packet (PDF) — Bankruptcy Questionnaire; opens in a new tab

Forms are private and only visible to the attorney and her staff. Submitting a form does not create an attorney-client relationship.