Form 1: Intake Questionnaire
Your Information
Your name as it is written on your driver’s license or passport:
First Name
Last Name
Are you married?
Yes
No
Your full legal name as it is written on your marriage certificate:
First Name
Last Name
Your full legal name on the day before the marriage date:
First Name
Last Name
Your Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
You have been a resident here since:
-
Month
-
Day
Year
Date
Your Home or Cellphone Number:
Where you can be reached
Format: (000) 000-0000.
Your Work Phone Number:
Where you can be reached
Format: (000) 000-0000.
Your Email Address:
example@example.com
Your Date of Birth:
-
Month
-
Day
Year
Date
Please provide a copy of your government-issued photo ID.
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Employer Address:
Ex. Company Address
Employer Name:
Ex. Company Name
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Other Party's Information
Full legal name of the other party (as it is written on their driver’s license, passport, etc.):
First Name
Last Name
First name on the day before the marriage date (other party):
First Name
Last Name
Last name on the day before the marriage date (other party):
First Name
Last Name
Their present address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
They have been a resident here since:
-
Month
-
Day
Year
Date
Their email address:
example@example.com
Their telephone number:
Please enter a valid phone number.
Format: (000) 000-0000.
Their date of birth:
-
Month
-
Day
Year
Date
Do they already have a lawyer? If yes, please provide the name and law firm:
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Separation Information
When did you start living together?
-
Month
-
Day
Year
Date
What is the date of marriage?
-
Month
-
Day
Year
Date
Where were you married? (city, province)
Do you have the original copy of your marriage certificate?
Yes
No
Please upload a copy of your marriage certificate.
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What was the date of your separation?
-
Month
-
Day
Year
Date
Have you been divorced before?
Yes
No
Where were you divorced? (city, province)
Date of your previous divorce:
-
Month
-
Day
Year
Date
Has the other party been divorced before?
Yes
No
Where were they divorced? (city, province)
Date of their previous divorce:
-
Month
-
Day
Year
Date
Have you and the other party been involved in a court case before?
Yes
No
Please provide details on the previous case(s).
Have you and the other party made a written agreement (such as a separation agreement) dealing with any issues involved in this case?
Yes
No
What is the date when the Agreement was signed?
-
Month
-
Day
Year
Date
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Children's Information
Are there any children of the relationship?
Yes
No
Please enter the children's information:
Are any of these children under 18 years old, or still attending school?
Yes
No
Has a court order or written agreement been made concerning child support?
Yes, court order
Yes, written agreement
No
Please provide all the relevant details on the child support order or agreement.
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Retainer Payment Information
What is your preferred method of payment?
Credit Card
Email money transfer to payment@dolginfamilylaw.ca
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