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FAMILY LAW: CLIENT INTAKE FORM

If you are seeking legal representation for matters concerning family law, please fill out the below questionnaire. The information provided by you here will help us prepare your case and allow us to better represent you. Please note that your answers are protected by lawyer-client privilege.

Today’s date:

Repeat client:

Referred by:

PLEASE COMPLETE TO THE BEST OF YOUR ABILITY AND RETURN.

Full name:

Age:

Date of birth:

Place of birth:

Driver’s license no.:

Other ID (specify type & no.):

Resident address (#/street):

City/province/postal code:

Can we send mail to this address?

If not, please specify alternate address or preferred method of communication:

Resided at current address since:

If less than 1 year, prior address:

Specify, please check one:

Year you commenced living in Ontario:

Home Telephone:

Other (cell):

Email:

Fax No.:

Current employer:

Since (year):

Occupation(s):

Employer’s address (#/street):

City/province/postal code:

Work No.:

Fax No.:

Nature of matter:

OPPOSING PARTY’S INFORMATION

Full legal name of opposing party (i.e. the other side in the matter):

Opposing party’s relationship to you (i.e. spouse, former spouse, common-law etc.):

Opposing party’s date of birth (d/m/y):

Place of birth:

Opposing party’s address (#/street):

City/province/postal code:

Since (year):

Home No.:

Other (cell):

Email:

Opposing party’s employer:

Employer’s address:

Work No.:

Since (year):

Position/title:

Gross annual income:

S.I.N.

FAMILY INFORMATION

Have you and the opposing party ever lived together?

Date you commenced living together, if applicable (d/m/y):

If married, specify date (d/m/y):

Place:

Surname prior to marriage:

Surname at birth:

Opposing party’s surname prior to marriage:

and at birth:

If separated, indicate date of separation (d/m/y):

If divorced, indicate date of divorce (d/m/y):

Is there a pre-nuptial agreement, cohabitation agreement, marriage contract, paternity agreement, separation agreement or other written agreement?

If yes, please specify type of agreement:

Date entered into (d/m/y):

Is there a possibility of reconciliation?

Are there any child(ren) of the relationship between you and the opposing party?

IF SO,

Full Name

Date of Birth (d,m,y) and Age

Gender

Grade

Educational Institution

Now Living with

Any other children from another relationship?

Full Name

Date of Birth (d,m,y) and Age

Gender

Grade

Educational Institution

Now Living with

Do your child(ren) attend private school?

If so, please indicate any annual fees:

Is there a Court Order in place (re: child/spousal support, custody, access, division of property, etc.)?

Do you have an order for custody of the child(ren)?

If so, date of order (d/m/y):

Do you want sole or joint custody of the child(ren)?

If the child(ren) do not live with you, do you have access to the child(ren)?

If so, please specify the access that you have (i.e. weekends, mid-week, shared (at least 40 % of the time) etc.):

What kind of access do you want the other side to have to the child(ren)?

Specify:

Religious upbringing of child(ren), if any?

Do you want child support?

Do you want spousal support?

Are any of the parties supporting a former spouse or child(ren) of another relationship

ARE THE CHILD(REN) IN DAYCARE/AFTER SCHOOL CARE?

Child

Care Provider

Address

Monthly Fee

ARE THE CHILD(REN) ENROLLED IN ANY EXTRA-CURRICULAR ACTIVITIES (I.E. SWIMMING, KARATE, ETC.):

Child

Activity

Location

Monthly Fee

Are there any special concerns about the child(ren) eg. Health, or education?

Please specify – any extraordinary circumstances; possible changes in residence or employment; health concerns; other:

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