Divorce Mediation Questionnaire

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First name*

Last name*

Email*

Phone

County & State*

How long have you been married?*

How many biological children from this marriage?*

Are there any children from previous marriages/relationships?*

Do you own your home?*

Own

Rent

Other

Are both spouses on the mortgage & title?

Are you still living in your marital home?

Have either of you consulted or hired an attorney?*

Have you filed a Petition for Dissolution?*

I am ready to start mediation in the next:

30 days

30-60 days

3 months

I don't know. Just starting to look into it.

Other

Name of Spouse (Last, First)*

Email of Spouse*

Phone of Spouse*

Is spouse aware of this mediation inquiry?*

Yes

No

How did you hear of us?*

General notes about your situation and whether you want a 20 minute free phone consultation.

440-220-5905

Chesterland, OH

Enhanced Divorce Mediation & Counseling

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