ZIP Code or City: *

Date of marriage:

Date of separation:

The status of our relationship is:

We are living together but not married

We are not living together and never have been married

We are married and living together

We are separated and have not yet filed for divorce

We are separated and a divorce case has been filed

We are divorced and both living alone

We are divorced and I am now married to someone else

We are divorced and my ex-spouse is now married to someone else

We are divorced and we both are now married to others

Your Age:

Occupation:

The other parent or spouse's occupation is:

The other parent or spouse's gross annual income is:

$25,000 or less

$25,001-$50,000

$75,001-$100,000

$100,001-$125,000

$125,000+

Number of children:

Age of child/children:

Major assets include (with their approximate $ value):

Home $:

Vehicle(s) $:

Investment / Vacation Property $:

Stocks / Bonds $:

Cash / Savings / Checking $:

Other:

Major debts include (with their approximate $ value):

Credit Card $:

Mortgage $:

Vehicle Loan(s) $:

Personal Loan $:

Medical Bills $:

Rental Unit $:

IRS $:

Other:

Would you and your spouse consider having an experienced family lawyer mediate your matter?:

Yes, we would

Yes, I would, but I'm not sure about my spouse

Yes, I would, but my spouse will not

I'm not sure what mediation is

How well do you understand your legal situation or issue? Please select the statement that best applies to your situation:

I understand my legal issue.

I have a couple of questions.

I have a lot of questions.

Gross annual income:

$25,000 or less

$25,001-$50,000

$75,001-$100,000

$100,001-$125,000

$125,000+

One Line Summary of your Case: *

Describe your Case in Detail: *

First Name *

Last Name *

City *

State or Province *

Zip / Postcode *

Phone *

Email *

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Yes

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What level of experience would you like your lawyer to have?

No preference

6-15 years experience

1-5 years experience

over 16 years of experience

How Will You Pay?

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I can't pay.