* How many years have you been in your current relationship?

If you have any children, please list their names and ages:

Do you and your spouse/partner still reside together?

Yes
No

* Have you experienced or do you fear either physical or mental abuse or some other form of domestic violence?

Yes
No

Have you discussed child support or spousal support issues with your partner?

Yes
No

Have you discussed property division issues with your partner?

Yes
No

* Do you or your spouse/partner own any real property, seperately or together?

Yes
No

* Do either you or your spouse/partner have any interest in either a Family Business, 401k, IRA or any other form of Future Retirement Benefits

Yes
No

* Are you employed?

Yes
No

* Is your spouse/partner employed?

Yes
No

Describe your most immediate concerns or issues:

* What is the best method for the attorney to contact you?

Phone
Email

* Do you require any special contact instructions or do you have any preferences in returning your call.

Yes
No

Please state the best time to call and the number at which you wish to be contacted.

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