FAMILY QUESTIONNAIRE

  • FAMILY QUESTIONNAIRE

1. INFORMATION ABOUT CLIENT:

2. INFORMATION ABOUT SPOUSE

Do they already have counsel?

3. INFORMATION ON MARRIAGE/RELATIONSHIP

Are you currently married?

If married, are you currently living apart from your spouse?

4. DO YOU HAVE CHILDREN FROM THIS RELATIONSHIP? If yes:

Are they in daycare?

5. ASSETS (include fair market value)

Real Property
In the spaces below, please add the following information for each Real Property.

Vehicles, Motorcycles, Water Vessel
In the spaces below, please add the following information for each Vehicle, Motorcycle and Water Vessel.

Stocks
In the spaces below, please add the following information for Stocks.

Bank Accounts
In the spaces below, please add the following information for Bank Accounts; for each account.

Life Insurance Policy
In the spaces below, please add the following information for Life Insurance Policy.

Retirement Accounts (IRA, 401K, Other Retirement or Pension Accounts)
In the spaces below, please add the following information for Retirement Accounts.

Businesses
In the spaces below, please add the following information for Businesses.

6. DEBTS (include amount of debt)

7. INSURANCE

Do you currently have medical / dental / vision insurance?

Medical

Vision

Dental

Is this a family plan?

Are you and your spouse on the plan?

Are the child(ren) on the insurance?

8. Have you and your spouse / partner made any agreements (as to custody, child support, division of assets, payment of bills, etc)?

9. What are your major concerns and what do you want to learn from our meeting? Check all that apply:

HOW DID YOU HEAR ABOUT US?