Years married:

Are there children involved in the marriage? Are there children involved in the marriage? Yes No

Number of Children:

Has there been infidelity in the marriage? Has there been infidelity in the marriage? Yes No

Drug or Alcohol Abuse? Drug or Alcohol Abuse? Yes No

Domestic Violence? Domestic Violence? Yes No

Is Alimony going to be an issue? Is Alimony going to be an issue? Yes No

Do you own a home? Do you own a home? Yes No

Is there any debt? Is there any debt? Yes No

Are you still living together? Are you still living together? Yes No

If Yes, does living together create conflict? If Yes, does living together create conflict? Yes No

Please explain any major conflicts that need to be discussed:*

Name

Address

Phone

Mobile / Text

Email Address

(Our representative will contact you by your preferred mode of communication.) (Our representative will contact you by your preferred mode of communication.) Phone Text Email

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