Bankruptcy Initial Consultation Form

This is the form we like filled out before your first appointment to discuss debt and bankruptcy options.  If you have not scheduled an appointment, you may fill this out, and either schedule an appointment online or call us to schedule, or we can call you. Even if you don’t want to file bankruptcy, this information is helpful in analyzing your options.

Bankruptcy Initial Consultation Form

Basic Information

Contact Information

Employment Information

Other Sources of Income

In the last six months, including part-time job, 401(k) withdrawals

Other Sources of Income

Child support, unemployment, worker’s comp, maintenance



What is the approximate total amount of your unsecured debts and what kind of debts do you have. We just need a general idea here; not a breakdown. (Your secured debts are discussed on the next page.)

Do you own real property, including timeshares


Other Titled Assets

Do you have any other liquid assets, retirement accounts, stocks, bonds, money in the bank
(including joint accounts with other people), 401(k)/IRA, etc.


(Note – if your tax refunds get direct deposited into a bank account where you owe $$ to the bank and are not current, they can take it)

Do you have a bank account