Family Law Questionnaire Template Page 6
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9Does any child have any special medical, educational or developmental needs?
Yes
No
If yes, please provide the nature of those needs
Do you feel that you or the other party have used excessive discipline with the child(ren)?
Yes
No
If yes,explain:
Is health and/or dental insurance available for the child(ren)?
Yes
No
If yes,please provide the nature of that coverage:
Provided by:
Wife/Mother
Husband/Father
MILITARY
Is either party currently serving in the military?
Wife/Mother:
Yes
No
Husband/Father:
Yes
No
If yes, where are they stationed
Do you have contact information for them?
Wife/Mother:
Yes
No
Husband/Father:
Yes
No
If yes, where are they stationed
RELIGIOUS AND FRATERNAL BACKGROUND
Please list the social and fraternal organizations to which you belong:
Please list your religious affiliations at the present time:
If you are active in your religion, please provide the name and contact information for your
pastor, rabbi or priest:
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