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CLIENT QUESTIONNAIRE
All information provided is strictly confidential

Personal Information
Home Business
Lawyer Information
   ext.
Business/Occupation
   Full time Part time
     
   

Relationship Information
Yes No
Yes No
 
Wife Husband
Wife Husband Mutual

CHILDREN OF PRESENT MARRIAGE/RELATIONSHIP Begin with oldest child

Legal Name
First, Middle, Last
Date of Birth
MM/DD/YYYY
M/F Primarily
Resides with
Grade School Lawyer
Y/N
1   Yes
No
2   Yes
No
3   Yes
No
4   Yes
No
5   Yes
No

POSSIBLE ISSUES IN DISPUTE
Yes No

Custody
Access
Child Support
Spousal Support
Division of Property
Pension
Debts of Wife
Debts of Husband
Equalization Payment
Matrimonial Home (Possession, Vacate, Sale, Other)

PRESENT RELATIONSHIP

CHILD SUPPORT

Yes NoIf yes, amount per month:
Are payments made regularly? Yes No F.R.O. (Family Responsibility Office): Yes No
Yes NoIf yes, amount per month:
Are payments made regularly? Yes No F.R.O. (Family Responsibility Office): Yes No
Child's NameSpecial Extraordinary ExpensesMonthly AmountYearly AmountPaid By
%
Available Tax Credit/Deduction
1
2
3
4
5
6
7
8
9
10
11
12

SPOUSAL SUPPORT
Yes No If yes, how much per month?
Yes No F.R.O. (Family Responsibility Office) Yes No
Yes No If yes, how much per month?
Yes No F.R.O. (Family Responsibility Office) Yes No

PREVIOUS RELATIONSHIPS
Yes No
Wife Yes No If yes, date of cohabitation, marriage, divorce, death:
Husband Yes No If yes, date of cohabitation, marriage, divorce, death:

CHILDREN FROM PREVIOUS MARRIAGE(S)/RELATIONSHIPS

Wife:

Legal Name
First, Middle, Last
Date of Birth
MM/DD/YYYY
M/F Primarily
Resides with
Grade School Lawyer
Y/N
1 Yes No
2 Yes No
3 Yes No
4 Yes No

Husband:

Legal Name
First, Middle, Last
Date of Birth
MM/DD/YYYY
M/F Primarily
Resides with
Grade School Lawyer
Y/N
1 Yes No
2 Yes No
3 Yes No
4 Yes No
Paying Receiving Amount:
Paying Receiving Amount:

PARENTING ISSUES
Yes No
Yes No
a) Children's Health Care By My Spouse By Me Jointly
b) Children's Education By My Spouse By Me Jointly
c) Children's Religious Training By My Spouse By Me Jointly
d) Children's Extracurricular Activities By My Spouse By Me Jointly
e) Payment for Extracurricular Activities By My Spouse By Me Jointly
f) Household Finances By My Spouse By Me Jointly
Verbal Abuse Physical Abuse Alcohol/Drug Abuse
In the past six months? By My Spouse By Me By My Spouse By Me By My Spouse By Me
At any time in relationship? By My Spouse By Me By My Spouse By Me By My Spouse By Me

PROFESSIONAL SERVICES Yes No
Yes   No Yes   No

Yes   No

CURRENT RESIDENTIAL ARRANGEMENTS
WEEK Monday Tuesday Wednesday Thursday Friday Saturday Sunday
 
1
2
3
4
Too much time?
Too little time?
The right amount of time?



NEW RELATIONSHIPS Yes No Yes No

Yes No
Name Age M/F Primarily Resides with
1
2
3


Yes No Yes No

Yes No
Name Age M/F Primarily Resides with
1
2
3

Yes No