CONFIDENTIAL INTAKE QUESTIONNAIRE

Divorce

PLEASE REVIEW. The following questionnaire is provided to prospective clients who wish to have a representative of Divorce PRO Wisconsin assess their case for future divorce mediation services. By completing and submitting this questionnaire, client is accepting Divorce PRO's offer of a free consultation without any obligation on the part of either client or Divorce PRO to engage in any further action. All information obtained will be used solely for the purposes described herein and will not be disseminated to any third parties without the client's written consent.

  • ABOUT YOU
  • OTHER PARTY
  • MORE INFO
  • MARRIAGE
  • DISCLOSURE
Your Contact Info
Your Additional Info
Are you currently in the U.S. Military
Other Party Contact Info
Other Party Additional Info
Is the other party in the US Military?
Additional Questions
Are either of you on Social Security, Welfare, W-2, AFDC, Food Stamps, or Title 19?
Have you been a resident of the State of Wisconsin for at least the last six (6) months?
Have you been a resident of the county in which you live for at least the last thirty (30) days?
Have you or your spouse filed any other action for divorce, annulment, legal separation, or paternity with regard to this particular relationship?
Do you believe that your marriage is irretrievably broken?
Are you currently separated?
About the Marriage
Do you have any children by this marriage?
Do you have any children who are not the product of this marriage?
Is legal custody (i.e. decision-making authority) or physical placement (i.e. the child's future residence) at issue?
Are you or your spouse pregnant?
The following information pertains to your Financial Disclosure Statement, which the Court will require you to prepare and file prior to any hearing involving financial issues and/or prior to the granting of a judgment of divorce.
Do either of you own real estate?*
Do either of you own a vehicle?
Do either of you own retirement accounts, pensions, or whole life insurance policies?
Do either of you maintain a deposit account having a balance of more than $500.00?
Do either of you own a business or have an interest in a business enterprise?
Do either of you own property that you believe is not subject to division as part of the marital estate (i.e. inherited property, gifts, personal injury awards, etc)?
Do either of you owe money?
Have either or both of you filed for bankruptcy?