Intake Application for Carnell Smith Consulting
Please complete this Intake Application for a complimentary consultation.
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Email *
Name *
Enter your first name and last name
Phone Number
Enter your contact number
City and State *
What is your country of citizenship?
US Citizens should enter "USA" and all others to enter the country of citizenship
Is there an existing court order with your name on it requiring you to pay child support? Y/ N
Clear selection
What kind of court order is it, if it's open now? Or what kind was it, if it is closed now?  
Default Judgment, Divorce Decree (Initial or Final), Initial Set Child Support and Establish Paternity, Social Security, Probate, Legal Separation, Termination of Parentage or other
How many children are listed in your court order? Please show the number of children and the current age of each child.
Are any of the children currently disabled, mentally or physically impaired? Y / N
Clear selection
What state issued the original child support order in your case?
Is the court case for child support in arrears or is it paid up currently up to date?  Y / N
Clear selection
Do you owe any arrears, what is the amount owed and what type of punitive actions have you experienced?License suspended, tax intercepts, jail, prison, accounts seized
What is your current state of legal residence?
What is the current state of legal residence for the child(ren) and the other parent?
What’s the estimated total monthly financial impact to your household now?  The monthly amount you are paying on the case(s)
How has this problem or concern affected you and/or your current household in the following areas Financial / Emotional/ Legal /Physical/ Spiritual (FELPS)? *
Have you been to court to do something about your family law case?
Clear selection
If you have been to court to do something about your case, summarize what happened?
How do you handle resistance, setbacks, and challenges when attempting to accomplish a goal? *
Why are you interested in working with Carnell Smith - The Paternity Coach?
How urgent is it for you to get started (Scale 1 someday (future)  to 10 -now)?  Enter  from 1 to 10
What is your budget for working on this issue (select one option)?
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A copy of your responses will be emailed to the address you provided.
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