New Client Questionnaire
Please fully complete this questionnaire. We will contact you with any questions we may have.
* Required
Email address
*
Your email
NAME
*
Your answer
PHONE NUMBER
*
Your answer
MAILING ADDRESS (INCLUDE CITY & STATE)
*
Your answer
TYPE OF CASE
*
Your answer
NEW OR EXISTING CASE?
*
NEW CASE
EXISTING CASE
HAVE PAPERS BEEN SERVED? IF SO, WHEN?
*
Your answer
COUNTY OF CASE
*
Your answer
DATE OF BIRTH
*
MM
/
DD
/
YYYY
PLACE OF EMPLOYMENT
*
Your answer
GROSS MONTHLY INCOME
*
Your answer
OTHER PARTY'S NAME
*
Your answer
OTHER PARTY'S ADDRESS
*
Your answer
WIFE'S MAIDEN NAME *IF APPLICABLE*
Your answer
DOES WIFE WISH TO RESTORE HER MAIDEN NAME?
Yes
No
Maybe
OTHER PARTY'S GROSS MONTHLY INCOME
Your answer
DATE OF MARRIAGE *IF APPLICABLE*
MM
/
DD
/
YYYY
CITY AND STATE OF MARRIAGE
Your answer
DATE OF SEPARATION
MM
/
DD
/
YYYY
REASON FOR DISSOLVING THE MARRIAGE *DIVORCE CASES ONLY*
INFIDELITY
FINANCIAL ISSUES
MENTAL/PHYSICAL/PSYCHOLOGICAL ABUSE
INCOMPATIBILITY
OTHER
Other:
WILL SPOUSAL SUPPORT BE REQUESTED?
Yes
No
Maybe
PROPERTY INVOLVED *DIVORCE CASES* -PLEASE SPECIFY HUSBAND'S/WIFE'S
Your answer
DEBT INVOLVED *DIVORCE CASES*
Your answer
WERE THERE CHILDREN BORN OR ADOPTED DURING THIS RELATIONSHIP/MARRIAGE?
*
YES
NO
Other:
CHILDREN INVOLVED (NAME & DATE OF BIRTH)
*
Your answer
CITY/STATE OF BIRTH OF CHILDREN
Your answer
WITH WHOM DO THE CHILDREN RESIDE?
MOTHER/WIFE
FATHER/HUSBAND
GRANDPARENT
OTHER RELATIVE
OTHER
Other:
VISITATION SCHEDULE FOR CHILDREN
Your answer
HOW WILL HOLIDAYS BE DIVIDED FOR CHILDREN?
Your answer
WHICH PARTY WILL CLAIM THE CHILDREN ON TAXES?
Your answer
LIST THE ADDRESSES AND DATES WHERE THE CHILD(REN) HAVE RESIDED FOR THE PAST 5 YEARS.
Your answer
WHO WILL PROVIDE MEDICAL/DENTAL INSURANCE FOR THE CHILDREN?
Your answer
WHICH PARTY WILL PAY CHILD SUPPORT? *IF APPLICABLE*
Your answer
IS EITHER PARTY COURT ORDERED TO PAY OR RECEIVE CHILD SUPPORT? IF YES, HOW MUCH?
*
Your answer
IS EITHER PARTY CURRENTLY SERVING IN THE MILITARY?
*
Yes
No
IF YES, WHERE ARE THEY STATIONED?
Your answer
DO YOU JOINTLY OR SEPARATELY OWN ANY PROPERTY? IF YES, PLEASE LIST.
*
Your answer
IF YES, WAS THIS PROPERTY OBTAINED BEFORE OR DURING THE MARRIAGE/RELATIONSHIP?
Your answer
HAS THERE BEEN A HISTORY OF ABUSE WITH THE OPPOSING PARTY?
*
Yes
No
PLEASE PROVIDE ANY PERTINENT INFORMATION THAT WE HAVE NOT ADDRESSED.
Your answer
Referred to our office by:
*
Your answer
Send me a copy of my responses.
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