1. Please give me a name or word which you choose to identify
yourself. The information contained in this questionnaire is confidential and will not be shared with anyone outside
our office.
Do you wish to be contacted first by return e-mail?
Yes
No
Next tell me your town or city of residence, whether you
are male or female, whether you have children and how many.
2. Are you seeking a divorce, the dissolution of a domestic
partnership, a modification of a previous case or are you an unmarried parent seeking to establish paternity, custody, timesharing
or support?
Seek a divorce or dissolution
Been served with divorce / dissolution papers
To modify terms of a previous judgment-skip to #5
Unmarried mother-skip to #5
Unmarried father-skip to #5
3. How long have you been married or living together in
a domestic partnership?
1-5 years
5-10 years
10-15 years
More than 15 years
4. If you have minor children, will custody be a contested
issue? Are you seeking custody?
I will be seeking custody of our children
I expect my spouse / partner to have custody
I seek adequate timesharing
We may need a professional custody evaluation
5. Are you presently the custodial parent? Have you had
physical custody for at least the last 30 days, excluding holidays?
Yes
No
6. If you answered Yes, do you incur monthly day care costs
as a result of work or full-time school? If so, how much?
7. Whether or not you are the custodial parent, do you incur
the monthly cost of medical insurance for the child or pay extraordinary medical expenses, dental or orthodontia expenses
directly? How much?
8. What is your occupation? How long have you worked in
this position? Do you work full-time?
9. What is your annual income - from all sources - including
salary, bonuses, commissions and investments?
10. If you are seeking a modification of a previous judgment
or decree, please check all that apply:
A change in custody
A change in child support or spousal support
A change in the amount or schedule of timesharing
Other issues
11. Will there be contested property issues involving one
or more of the following? (check all that apply):
Real Property
Business Interests
Household Furnishings
Vehicles (Autos, Trucks, Motorcycles)
Recreational Vehicles (RV's, Boats, etc.)
Jewelry, Art or Collectibles
Farm Animals or Pets
12. What is your estimate of the value of any real property
which needs to be awarded in this case:
13. Do you or your spouse have a retirement plan, pension,
401K, IRA or Keough which needs to be divided or awarded:
Yes
No
14. If you and your spouse have reached an amicable settlement
of your differences, you may be interested in entering into a Marital Settlement Agreement before you begin the divorce or
dissolution process. Does an MSA interest you?
Yes
No
15. Please give me a brief statement of your situation and
mention any questions you may have that have not been addressed in this survey:
* Indicates a required
field
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