Please complete the following Intake Form proir to your first meeting.

General Information:

(Date of Marriage/Cohabitation)

(Date of Separation)

Information About Opposing Party:

Issues Disputed: (Check any that apply)

 Custody of the Children and Primary Residence of the Children?

 Access to the Children?

 Child Support?

 Does your Partner have Health/Dental/Medical Insurance?

Special Expenses of the Children:

 Are the Children Enrolled in Extracurricular Activities?

 Do the Children have Health Needs?

 Are the Children Enrolled in a Full Time Program at College or University?

 Extraordinary (or Special Expenses) Payment Per Month?

Spousal Support:

Division of Property:
Assets & Debts: (Enter Dollar Values)

(RRSP/Pension/Jewelry/Vehicles)

(Mortgage/Line of Credit/Credit Cards/Other Debts)