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Name

First Name

Last Name

What or who motivated you to meet with me?

What is your relationship/marriage status?

Are you still together, or have you separated?

If your relationship/marriage is ending, are you the initiator?

What are your three biggest concerns?

What are the three most important outcomes for your divorce?

Are you in fear for your safety or for the safety and wellbeing of any members of your household?

Is there anything else you would like me to know that wasn't covered here?