TLC Family Law Practice
Putting the Pieces Together with TLC

Intake questionnaire

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In Depth Contact Form

The following is an in-depth confidential intake questionnaire. If you are looking for general inquiries please return to our contact page.

 

for our intake questionnaire, Please complete the form below

Date *
Date
I expressly consent to the collection of the within information for the purposes of my summary discussions with Tracy L. Clark and any subsequent engagement of her services. *
How did you hear about our firm?
Part One - General Information
Name *
Name
Your Spouse/Partner
Your Spouse/Partner
New Spouse
New Spouse
Physical Address
Physical Address
Mailing Address
Mailing Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Employment Start Date
Employment Start Date
$
Birthdate
Birthdate
Are either you or your spouse/partner in bankruptcy?
Do you or your spouse/partner have a disability or medical condition?
General Information of your Spouse/Partner
Your Spouse's Name
Your Spouse's Name
Your Spouse's Physical Address
Your Spouse's Physical Address
Your Spouse's Mailing Address
Your Spouse's Mailing Address
Your Spouse's Home Phone
Your Spouse's Home Phone
Your Spouse's Cell Phone
Your Spouse's Cell Phone
Your Spouse's Work Phone
Your Spouse's Work Phone
Your Spouse's Employment Start Date
Your Spouse's Employment Start Date
$
Your Spouse's Birthdate
Your Spouse's Birthdate
Part Two - Your Relationship
Date you started living together
Date you started living together
Have you separated from your spouse/partner?
Date of Separation
Date of Separation
Are you and your spouse/partner married?
Date of Marriage
Date of Marriage
Your Marital status at time of Marriage
Your Spouse's Marital status at time of Marriage
Has there been any violence in your relationship?
Part Three - Previous Steps Taken
Have you entered into any sort of an agreement (prenuptial or otherwise) with your spouse/partner?
Has either Party started Court proceedings
Are there any Court dates set?
Have any Orders been issued in the past with respect to your family matter?
Part Four - Your Children
Child One - Name
Child One - Name
Birthdate
Birthdate
Biological child of both parents?
Your step-child?
Your child from a previous relationship?
Child Two - Name
Child Two - Name
Birthdate
Birthdate
Biological child of both parents?
Your step-child?
Your child from a previous relationship?
Child Three - Name
Child Three - Name
Birthdate
Birthdate
Biological child of both parents?
Your step-child?
Your child from a previous relationship?
Who was the primary caregiver prior to separation?
Who has been the primary caregiver since separation?
Who should have primary care of the Children now?
Is the other parent unfit?
Is support being paid?
$
Part Four - Your Assets & Debts
FAMILY RESIDENCE Address
FAMILY RESIDENCE Address
$
$
Is this a mobile home?
What would you like to do with the home?
OTHER PROPERTIES
Do you or your spouse/partner own any other properties?
Address:
Address:
$
$
Is this a mobile home?
Address:
Address:
$
$
Is this a mobile home?
Motor Vehicles
$
$
$
$
$
$
OTHER ASSETS:
DEBTS