Child Custody Questionnaire

CHILD CUSTODY QUESTIONNAIRE
Your answers to the following questions are completely CONFIDENTIAL and are protected by ATTORNEY-CLIENT-PRIVILEGE. This information will not be shared with anyone other than those working on your case. Your response to these questions now will help organize your case and save litigation expenses in trying gather and assemble information after the case is in progress.

Please fill out this questionnaire completely and honestly and return it to our office as soon as possible. It is imperative that you are open and honest with your answers so that we may serve you to the best of our abilities. You should answer all questons relevant to your case. If a question is not relevant, please mark the question "N/A". If you require more space, please complete your answer on a separate shee, indicate the section and questions to which you are answering, and attach it to this questionnaire.
BACKGROUND INFORMATION

CLIENT INFORMATION
Name*

First NameLast Name
Email*
example@example.com
Client Name:
Mailing Address:
Email Address:
Home Telephone No.:   Area Code   Phone Number
Cell Phone:    Area Code   Phone Number
Driver's License No.:             State:
Social Security Number:
Date of Birth:   Date       City of Birth:
Employer:
Employer's Phone Number:          Area Code   Phone Number
Employer's Address:  Street Address   Address Line 2   City   State   Zip
Salary: $      Position:
Length of Time with Present Employer:
Please list your full addresses and dates of residence, in chronological order, for last five (5) years.
BACKGROUND INFORMATION

OPPOSING PARTY INFORMATION
Spouse Name:   First Name   Last Name
Mailing Address:      Street Address   Address Line 2   City   State   Zip
Email Address:      Email
Home Telephone No.:   Area Code   Phone Number
Cell Phone:    Area Code   Phone Number
Driver's License No.:             State:
Social Security Number:
Date of Birth:   Date       City of Birth:
Employer:
Employer's Phone Number:          Area Code   Phone Number
Employer's Address:  Street Address   Address Line 2   City   State   Zip
Salary: $      Position:
Length of Time with Present Employer:
INFORMATION ABOUT CHILDREN

Basic Information
Child #1
Name:   First Name   Last Name   Social Security Number:
Date of Birth:   Date   Birthplace:
Sex:   Male   Female   School and Grade (if applicable)
Child #2
Name:   First Name   Last Name   Social Security Number:
Date of Birth:   Date   Birthplace:
Sex:   Male   Female   School and Grade (if applicable)
Child #3
Name:   First Name   Last Name   Social Security Number:
Date of Birth:   Date   Birthplace:
Sex:   Male   Female   School and Grade (if applicable)
Child #4
Name:   First Name   Last Name   Social Security Number:
Date of Birth:   Date   Birthplace:
Sex:   Male   Female   School and Grade (if applicable)
Child #5
Name:   First Name   Last Name   Social Security Number:
Date of Birth:   Date   Birthplace:
Sex:   Male   Female   School and Grade (if applicable)
Child #6
Name:   First Name   Last Name   Social Security Number:
Date of Birth:   Date   Birthplace:
Sex:   Male   Female   School and Grade (if applicable)
Other Relationships

If either you or the other parent have children from other relationships, please complete the following section.
Name of Your Former Spouse(s)/Partner(s):
  First Name   Last Name
  First Name   Last Name

Names and Dates of Birth for Children of Prior Marriage/Relationship:
1)    First Name   Last Name DOB:   Date
2)   First Name   Last Name    DOB:   Date
3)   First Name   Last Name    DOB:   Date
Name of Other Parent's Former Spouse(s)/Partner(s):
First Name   Last Name
First Name   Last Name

Names and Dates of Birth for Opposing Party's Children of Prior Marriage/Relationship:
1)   First Name   Last Name    DOB:   Date
2)   First Name   Last Name    DOB:   Date
3)   First Name   Last Name    DOB:   Date
SPECIFIC CRITIQUES OF PARENTS
List all negative qualities you believe the other parent will say about you.
What basis or evidence, if any, does the other parent have to claim the negative qualities listed above?
State in detail why you are a good parent.
State the three most positive things you can say about the other parent's parenting of your child(ren).
State in detail your concerns, if any, regarding the other parent's parenting of your child(ren).
State in detail why the other parent is or is not a good parent.
State the legal custody arrangement (i.e. decision-making for major issues) you feel is best for your child(ren).
State the physical custody arrangement (i.e. parenting time/schedule) you feel is best for your child(ren).
Which parent do the child(ren) primarily live with, and how long has this arrangement been in place?
Does the other parent suffer from any diagnosed mental health conditions or disorders? If so, state each diagnosis, including the date of the diagnosis, and whether he/she is prescribed medication.
Does the other parent attend therapy/counseling? If so, identify his/her therapist/counselor, if known, and state the period of time he/she has been seeing the provider and the reason(s) for attending therapy.
Do you suffer from any diagnosed mental health conditions or disorders? If so, state each diagnosis, including the date of the diagnosis, and whether you are prescribed medication.
Do you attend therapy/counseling? If so, identify your therapist/counselor, the period(s) of time you have been seeing the provider and the reason(s) for attending therapy.
CARE OF THE CHILDREN

To the extent that both you and the other parent have shared parenting responsibilities listed below, indicate which parent is primarily responsible for each task, or enter "shared" if the task is shared equally.
Who helps the children get dressed in the morning?
Who bathes the children and grooms them?
Who takes care of the children during the day?
Who arranges childcare for the children?
Who arranges for getting the children together with playmates?
Who puts the children to bed at night?
Who prepares the meals?
Who arranges for medical and dental care and take the children to doctor's appointments?
Who takes children to school?
Who picks the children up from school?
Who shops for the children's clothes?
Who transports the children to extracurricular activities?
Who arranges for medical and dental appointments?
Who takes the children to medical and/or dental appointments?
Who arranges the children's birthday parties?
Who helps the children with their homework?
Who attends parent-teacher conferences?
Who cares for the children when they are ill?
Who disciplines the children?
Please list the schools the child(ren) have attended, dates of attendance, and the name of teacher or principal who is familiar with each child.
Do you or the other parent participate in recreational or education activities with the children?
Describe the nature of the activities and how often you and the other parent participates in them.
Are the children more likely to turn to you or to the other parent when they have problems? Why?
Do you feel the children are closer to you or the other parent? Why?
Are the children currently in day-care or with a child care provider? If so, how many hours per week?
Give name, address and telephone number of the day care service or child care provider:
Have there ever been any issues with day care or child care provider? (i.e., standard of care, disciplinary issues, asked to leave day care center or care provider refused to come back.)
Are there any disagreements or differences between you and the other parent when it comes to disciplining the children? If so, explain.
Has the division of parenting responsibilities for the children changed over the years? If so, explain these changes.
Has either parent interfered with the children's relationship with the other parent or spoken badly about the other parent in the presence of the children? If so, please explain in detail.
Has either parent blocked the other parent's visitation with the children? If so, please explain in detail, giving dates and frequency with which visitation was blocked.
Has either parent discouraged the children from having a relationship with a step-parent, dating partner or other significant person in the other parent's life? If so, please explain in detail.
Describe how well you and the other parent cooperate on matters concerning the children and on matters concerning visitation or access to the children.
Describe your communication with the other parent regarding matters concerning the children.
TIME AVAILABLE TO SPEND WITH THE CHILDREN AND PLANS FOR THEIR FUTURE CARE.
What is your typical work schedule each week? What time do you leave home and return home from work?
Do you have flexible working hours? If so, describe your flexibility with work.
Does your work require travel? If so, describe the distance and frequency you are required to travel.
What are your plans for child care?
Describe your housing arrangements, sleeping arrangements including number of bedrooms.
What is the other parent's work schedule? What time does he/she leave home and time return home?
Does the other parent have flexible working hours? If so, describe his/her flexibility with work.
Is the other parent required to travel for work? If so, describe the distance and frequency he/she is required to travel.
What are the other parent's plans for childcare?
Is the other parent's work schedule likely to change in the future? If so, describe the anticipated change.
Describe the other parent's housing arrangements, sleeping arrangements including number of bedrooms.
SPECIAL NEEDS OF THE CHILDREN
Do any of the children have any special or unique educational or health care needs? If so, describe the need in detail.
Have both parents worked to meet those needs? How so?
Have there been any changes in the children's academic performance in the last few months or years? If so, describe the change and the reason for the change.
Which parent is better able to meet those needs? How so?
Has any healthcare professional prescribed medication to your child(ren)? If so, state each medication, when the child was prescribed, and the reason for which the medication was prescribed.
Have there been any disputes between you and the other parent regarding medication for the child(ren)? If so, state in detail the nature of the dispute and when this occurred.
Are any of the children attending therapy/counseling? If so, identify each provider he/she has seen, the period of time the child has seen the provider and the reason for attending therapy/counseling.
Have you and the other parent had any disputes regarding therapy/counseling for the child(ren)? If so, state in detail the nature of the disagreement, when the disagreement occurred and whether this is still an issue.
SENSITIVE TOPICS

Have you or the other parent ever:
Committed a Felony:

YesNo
Been Arrested:

YesNo
Been in Jail or Prison:

YesNo
Used Illegal Drugs:

YesNo
Abused Alcohol:

YesNo
Been Arrested or Convicted for DWI/DUI (alcohol or drugs):

YesNo
Engaged in any Other Illegal Activity:

YesNo
Attempted Suicide:

YesNo
Been Hospitalized for any Emotional or Psychiatric Disorder:

YesNo
Suffered from or Received Treatment for an Emotional or Psychiatric Disorder:

YesNo
Taking any Type of Prescription Drug(s):

YesNo
Abused a spouse or partner:

YesNo
Been Accused of Abusing a spouse or partner:

YesNo
Sexually Abused a Child:

YesNo
Been Accused of Sexually Abusing a Child:

YesNo
Introduced your Children to a Dating Partner:

YesNo
Suffer from a Physical Disability that impacts your ability to care for your Children:

YesNo
CHILDREN'S PREFERENCES
If you answered "yes" to any of the above questions, please explain the circumstances in detail.
Have the children told you which parent they want to live with? If so, what is the basis for this preference?
Type a question
How strong is the children's preference?
How long have the children held this preference?
Has the children's preference changed over time?
How do you feel about the children speaking with a judge regarding their preference?
Have you noticed any change in any of the children's behavior that is unusual or causes you concern? If so, name the child and describe his/her change in behavior in detail.
WITNESSES

Below, please list who you think would make good witnesses for you and what you think their testimony would be. (Possible witnesses include neighbors, the children's teachers, friends, doctors, baby sitters, daycare workers, clergy and family members.)
Name:blanks .
How do you know this person?blank
Address:     Street Address   Address Line 2   City   State   Zip
Phone Number:   Area Code   Phone Number
Anticipated Testimony:
Name:blanks .
How do you know this person?blank
Address:     Street Address   Address Line 2   City   State   Zip
Phone Number:   Area Code   Phone Number
Anticipated Testimony:
Name:blanks .
How do you know this person?blank
Address:     Street Address   Address Line 2   City   State   Zip
Phone Number:   Area Code   Phone Number
Anticipated Testimony:
Name:blanks .
How do you know this person?blank
Address:     Street Address   Address Line 2   City   State   Zip
Phone Number:   Area Code   Phone Number
Anticipated Testimony:
Name:blanks .
How do you know this person?blank
Address:     Street Address   Address Line 2   City   State   Zip
Phone Number:   Area Code   Phone Number
Anticipated Testimony:
Name:blanks .
How do you know this person?blank
Address:     Street Address   Address Line 2   City   State   Zip
Phone Number:   Area Code   Phone Number
Anticipated Testimony:
Type a question
Should be Empty:

CHILD CUSTODY QUESTIONNAIRE

BACKGROUND INFORMATION

BACKGROUND INFORMATION

INFORMATION ABOUT CHILDREN

Other Relationships

SPECIFIC CRITIQUES OF PARENTS

CARE OF THE CHILDREN

TIME AVAILABLE TO SPEND WITH THE CHILDREN AND PLANS FOR THEIR FUTURE CARE.

SPECIAL NEEDS OF THE CHILDREN

SENSITIVE TOPICS

CHILDREN'S PREFERENCES

WITNESSES