Custody Evaluation Questionnaire Template

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LUND & STRACHAN CUSTODY EVALUATION QUESTIONNAIRE
(No Confidentiality between parents)
A.
IDENTIFYING DATA
DATE: ________________________
Case Name and Number: _______________________________________
Your Present Name: ______________________________________________
Your Age: _____________ Date of Birth: ____________________________
Your Place of Birth: _______________________________________________
Your Religion: ____________________________________________________
Your Home Address: ______________________________________________
_________________________________________________________________
Your Home Phone No.__________________ Your e-mail ________________________
Fax No._________________________
Cell Phone No.___________________________
B.
EMPLOYMENT
Employer: _______________________________________________________
Type of Employment_____________________________________________
Length of Employment: __________________________________________
Address: _________________________________________________________
Phone No.: ___________________
Work Hours: ____________________
If you travel for employment, please describe: ____________________
_________________________________________________________________

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