Family Law Questionnaire Template (Page 4 of 9) in pdf

Family Law Questionnaire Template Page 4

Is there a police report?

 Yes

 No

If yes, please provide us with a copy.

Does either party have a problem with alcohol, drugs or other type of addictive behaviors?

Yes

 No

 Wife/Mother

 Husband/Father

If yes, please explain:

Is either party currently undergoing counseling or therapy for any reason?

Yes

 No

 Wife/Mother

 Husband/Father

If yes, please explain:

MARRIAGE/RELATIONSHIP HISTORY

Why do you believe that your marriage/relationship is irretrievably broken (broken beyond

repair)?

Have either of you had marital/couples or individual counseling?

Yes

 No

 Wife/Mother

 Husband/Father

If yes, with whom and for how long

If no, would you consider it at this time?

Yes

 No

Are there any conditions you would require before agreeing to counseling?

CHILDREN FROM THIS MARRIAGE AND/OR RELATIONSHIP

Is the Wife/Mother currently pregnant?

Yes

 No

If yes, due date:

Are there children born of this marriage and/or relationship?

Yes

 No

If yes, please provide the following information:

Name

D.O.B

Soc. Sec. Number

Present Address

Family Law Questionnaire Template Page 4