Client Questionnaire

Please print this page, fill it out, and bring it with you to your initial consultation. This information will assist us in assessing your situation.

Full name:
__________________________________________________

Name before marriage (if different):
__________________________________________________

Current address (including postal code):
__________________________________________________
__________________________________________________
__________________________________________________

Telephone number:
Home: _______________ Work: _______________

Fax number: _______________

E-mail address: ______________________________________

Billing address (if different from current address):
__________________________________________________
__________________________________________________
__________________________________________________

Spouse's full name:
__________________________________________________

Spouse's name before marriage (if different):
__________________________________________________

Spouse's current address (if different from yours):
__________________________________________________
__________________________________________________
__________________________________________________

Spouse's telephone number:
Home: _______________ Work: _______________

Spouse's lawyer (if known):
__________________________________________________

Name of person who referred you:
__________________________________________________

Children of marriage:
Name: ________________________ Date of Birth: _________________
  School:_______________________________ Grade: ________
Name: ________________________ Date of Birth: _________________
  School:_______________________________ Grade: ________
Name: ________________________ Date of Birth: _________________
  School:_______________________________ Grade: ________
Name: ________________________ Date of Birth: _________________
  School:_______________________________ Grade: ________

With whom are children now residing:
__________________________________________________

Date of marriage: _________________________

Place of marriage: ____________________________________

Date commenced cohabitation (if lived together before marriage):
_______________________

Date of separation: _________________________

Dates of any attempted reconciliation(s):
_________________________________________________

Do you have a copy of your marriage certificate? _______

Is this your first marriage? _______

Is it your spouse's first marriage? _______

If this is not your first marriage, list date and place of previous divorce:
__________________________________________________

Your date of birth: _________________________

Your place of birth: __________________________________

Your spouse's date of birth: _________________________

Your spouse's place of birth: ___________________________________

I have resided in Ontario since
(date): _________________________

My spouse has resided in Ontario since
(date): _________________________

Your formal education/qualifications:
__________________________________________________

Your spouse's education/qualifications:
__________________________________________________

If you are employed, the nature of job and name and address of employer:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

If your spouse is employed, the nature of job and name and address of employer:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Your present gross annual income: _______________________

Your spouse's gross annual income: _______________________

Have you and your spouse attended marriage counselling? _________
If yes, name of counsellor:
______________________________________

Do you or your spouse own your home or cottage? __________
If yes, how is title held?:
______________________________________

Address of properties:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

What is present market value of home? ______________

What mortgages are registered on title?
______________________________________
______________________________________
______________________________________