Family Law Questionnaire Template

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FAMILY LAW QUESTIONNAIRE
Please complete this questionnaire and return it to our office before your first appointment. If
you will spend the time to complete all items, we will then have the necessary background
information to understand the complexity of the personal aspects of your situation. All
information will be held in strictest confidence.
* Please feel free to attach additional pages should it become necessary
Referred to our office by:
Date:
Nature of current legal issue:
Dissolution of Marriage with or without children
Paternity and/or Establishment of Child Support
Post-judgment (Enforcement, Contempt, Modification)
AT WHAT LEVEL OF URGENCY DO YOU RATE YOUR CURRENT LEGAL ISSUE?
Critically urgent - Emergency situation needing immediate attention
Urgent - Need to take quick action
Important - Need to initiate action but there are no immediate issues
I just want to see what my options are at this time
Wife/Mother’s Name:
Address:
Contact Information:
Home -
Cell -
Work -
E-mail -
Facsimile -
Date of Birth:
Driver’s License Number:
* Please provide of a copy of your license
Social Security Number:
Maiden Name:
Requesting restoration of maiden name:
 Yes
 No
Husband/Father’s Name:
Address:
Contact Information:
Home -
Cell -
Work -
E-mail -
Facsimile -
Date of Birth
:
Driver’s License Number:
* Please provide a copy of your driver’s license
Social Security Number:

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