Please note that any information submitted through the use of this form will remain confidential.  Please further note that while this firm has taken reasonable precaution  to secure transmission of information, it is not recommended that any highly confidential information be submitted.

Your Name: (required)

Your Email: (required)

Source of Referral

Purpose of Inquiry:

Number of Year Married:

Marital Assets, check all that apply:
Home/Condo/Co-opMotor VehicleBoatStocks, Options, BondsRetirement PlansLife Insurance Policies

Approximate Total Value of Marital Assets:

Approximate Total Value of Marital Debt:

Total Number of Children Together:

Current Living Arrangement of the Children:

Is Either Spouse Making Child-Support Payments:

Current Living Arrangements:

What Best Describes Current Views? Check all that apply:
I am ready to get divorcedI am not sure if I am ready to get divorcedI know my spouse wants to get divorcedMy spouse does not want to get divorcedI don't know if my spouse wants to get divorced

What Best Describes Your Relationship?

Additional Information

Please note that the sole purpose of the Free Case Evaluation is to assist individuals in determining the divorce option most suitable for their individual needs and interests.  Please further note that submission of the above form does not automatically create an attorney/client relationship.