Client Information Questionnaire

Does the case involve divorce/separate maintenance involving children, paternity, child custody, adoption, guardianship of a child, domestic abuse, or other family related matter?*
Is wife/girlfriend pregnant?
Who do the children live with currently?
What is the current visitation arrangement?
Is there a visitation order in place at the current time?
Please list county, division, and case number of visitation order:
List each Child's Name, Date of Birth, and Social Security Number:
List whose name appears on each child's birth certificate, birth certificate number, and the birth certificate state:
List each Child's School, School Address, and Grade Level:
List any special needs of the children:
Pediatrician's Name
First Last
Pediatrician's Phone
Psychologist's Name
First Last
Psychologist's Phone
Psychiatrist's Name
First Last
Psychiatrist's Phone
Counselor's Name
First Last
Counselor's Phone

Client Information Questionnairethe information we need to help you