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Client Questionnaire

    Client Name:
    Phone:
    Email:
    City:
    State:
    Zip:

    Client Questionnaire—Divorce
    Please fill out this questionnaire and return it as soon as possible. It is important that you answer each question fully. It is imperative that you be candid!

    You should answer all questions relevant to your case. If a question does not apply to your particular situation, please indicate by marking the question "N/A.” If the answer to any question requires more space than has been provided on the form, please complete your answer on a separate sheet. Refer to the question number to which your answer applies and attach your answer to this questionnaire.

    Your responses to these questions will help to organize your case and will save you money on attorney’s fees in trying to gather and assemble information after the case is in progress. Since your answers are being made to an attorney, you are assured of confidentiality and are protected by the attorney-client privilege.

    NOTICE OF CONFIDENTIALITY
    THE INFORMATION IN THIS DOCUMENT IS SUBJECT TO THE ATTORNEY-CLIENT PRIVILEGE, AS PROVIDED IN THE TEXAS RULES OF EVIDENCE. HOWEVER, IF A PROFESSIONAL, INCLUDING AN ATTORNEY OR AN EMPLOYEE OF AN ATTORNEY, HAS CAUSE TO BELIEVE THAT A CHILD HAS BEEN ABUSED OR NEGLECTED OR MAY BE ABUSED OR NEGLECTED OR THAT A CHILD IS A VICTIM OF AN OFFENSE UNDER SECTION 21.11 OF THE TEXAS PENAL CODE, AND THE PROFESSIONAL HAS CAUSE TO BELIEVE THAT THE CHILD HAS BEEN ABUSED AS DEFINED BY SECTION 261.001 OR 261.401 OF THE TEXAS FAMILY CODE, THE PROFESSIONAL SHALL MAKE A REPORT NOT LATER THAN THE FORTY-EIGHTH HOUR AFTER THE HOUR THE PROFESSIONAL FIRST SUSPECTS THAT THE CHILD HAS BEEN OR MAY BE ABUSED OR NEGLECTED OR IS A VICTIM OF AN OFFENSE UNDER SECTION 21.11 OF THE TEXAS PENAL CODE. THE REPORT SHALL BE MADE TO THE APPROPRIATE AGENCY.

    THE CONTENTS OF THIS DOCUMENT CONSTITUTE ATTORNEY WORK PRODUCT, ARE CONFIDENTIAL, AND ARE NOT TO BE DISCLOSED TO THIRD PERSONS OTHER THAN THOSE TO WHOM DISCLOSURE IS MADE IN FURTHERANCE OF THE RENDITION OF PROFESSIONAL LEGAL SERVICES.

    Privacy Policy Regarding Social Security Numbers: Social Security numbers will be divulged only when necessary during the course and within the scope of our employment. The firm collects them from various sources, including income tax returns as well as the client. They are used to identify parties for a number of purposes, including determination of wages, preparation of orders to withhold wages for child support and reports filed with the state of Texas, and obtaining information about retirement benefits. Only employees of the firm who have a need to know will have access to this personal information. Every step is taken to protect the client’s privacy. This information is kept secure within the office of the firm in file folders and file drawers, until the file information is retired and the file is removed to a locked, off-site storage facility. Client information will eventually be shredded.

    About You
    Full Name
    		 Date of Birth
    Social Security Number
    		 Driver's License and State of Issue
    Maiden Name, if applicable
    		 Return to Maiden Name
    Current Street Address
    		 Current County
    Phone Number
    		 Email
    Place of Birth
    		 Ethnicity
    When and Where Married?
    		 When separated?
    Current Employer
    		 Employer's Address
    Job Title
    		 Salary
    Length of Employment
    		 Education/Training
    Disability or Reason for Unemployment
    		 How long have you lived in Texas?
    How long have you lived in County?
    Has there been any family violence or threat of family violence? If so, please give details and approximate dates:
    Have there been any applications for a protective order? If so, when?
    How were you referred?
    About Your Spouse/Partner
    Full Name
    		 Date of Birth
    Social Security Number
    		 Driver's License and State of Issue
    Maiden Name, if applicable
    		 Return to Maiden Name
    Current Street Address
    		 Current County
    Phone Number
    		 Email
    Place of Birth
    		 Ethnicity
    Current Employer
    		 Employer's Address
    Job Title
    		 Salary
    Length of Employment
    		 Education/Training
    Disability or Reason for Unemployment
    		 How long has he/she lived in Texas?
    How long has he/she lived in County?
    Will your spouse/partner be willing to sign a Waiver of Service of Process before a notary?
    If not, where would you like your spouse/partner served?
    Children Between You and Your Spouse/Partner or NO CHILDREN TOGETHER
    Name of Child
    		 Sex
    MaleFemale    		 Date of Birth and Age
    Place of Birth
    		 Social Security Number
    		 Disability If Any
    Name of Child
    		 Sex
    MaleFemale    		 Date of Birth and Age
    Place of Birth
    		 Social Security Number
    		 Disability If Any
    Name of Child
    		 Sex
    MaleFemale    		 Date of Birth and Age
    Place of Birth
    		 Social Security Number
    		 Disability If Any
    Name of Child
    		 Sex
    MaleFemale    		 Date of Birth and Age
    Place of Birth
    		 Social Security Number
    		 Disability If Any
    Current Arrangements for Children
    Who do the Children live with Currently?
    		 If over the age of 12 do the children have a preference who they will live with?
    		 What school do the children attend?
    What would you like to see as far as a possession schedule?
    Are there are any concerns about the children being with the other parent?
    Do either of you owe a duty of child support for any other children?