Client Intake Questionnaire Client Intake Questionnaire Client Contact Details Name: Phone Number: Address: Email: Maiden or Other Names: Preferred Contact Times: How did you find us? Preferred Lawyer Partner Contact Details Name: Phone Number: Email: Address: Maiden or Other Names: Preferred Contact Times: Parties Client Information Age (Client): Date of Birth (Client): Place of Birth (Client): Gross Income (Client): Occupation (Client): Years Residing in Alberta (Client): Marital Status at time of marriage (Client): Gender at time of marriage (Client): Repartnered? (Client): Partner Information Age (Partner): Date of Birth (Partner): Place of Birth (Partner): Years Residing in Alberta (Partner): Occupation (Partner): Gross Income (Partner): Marital Status at time of marriage (Partner): Gender at time of marriage (Partner): Repartnered? (Partner): Additional Details 1. Tell us about your current situation: 2. What are your desired outcomes? 3. Additional information about the relationship: Important Dates When did your relationship begin? When did you start living together? Date of Marriage Date of Separation Length of Cohabitation 1. Notes and Additional Information: Children and Parenting Children Name First/Middle/Last Age Date of Birth Place of Birth plus1 Add minus1 Remove Historical Arrangements Current Arrangements Children(s) Education Child Support Assessment Work Commitments for Client Work Commitments for Partner Desired Outcome Discussions So Far 1. Notes and Additional Information: Assets and Liabilities Assets as of Today (Client) Assets as of Today (Spouse) Assets as of Today (Joint) Debts as of Today (Client) Debts as of Today (Spouse) Debts as of Today (Joint) Net Position as of Today (Client) Net Position as of Today (Spouse) Net Position as of Today (Joint) Occupation (Client) Occupation (Spouse) Occupation (Joint) Gross Income (Client) Gross Income (Spouse) Gross Income (Joint) Assets: Extra Details Vehicle Make and Model Roughly how much is it worth now? Whose name is registered in? Who uses it? plus1 Add minus1 Remove Properties Address Value as of Today Mortgage Remaining Mortgage plus1 Add minus1 Remove Investments Registered or Non-Registered? RegisteredNon-Registered Financial Institution Who owns the investment? Or, can you specify numbers of shares? What is the total value of the investment? plus1 Add minus1 Remove Any additional information you would like your lawyer to know: Captcha Submit Save Draft If you are human, leave this field blank. Δ
