New Client Questionnaire
Full Legal Name
Preferred Name for Emails
Pronoun Preference
Mobile Phone
Date of Birth *
Company
Street Address
City
State
Zip Code
Spouse Full Legal Name
Spouse Date of Birth
Your or your Spouse's maiden name, if applicable
Location of Marriage (City, State)
Date of Marriage
Have you been a Connecticut Resident for 12 months?
Has your Spouse retained an attorney?
Yes
No
Opposing Counsel Name
For the following question, do not include children from other relationships
Do you and your Spouse have children together?
Yes
No
Legal Name and Date of Birth of Child 1
Legal Name and Date of Birth of Child 2
Legal Name and Date of Birth of Child 3
Legal Name and Date of Birth of Child 4
Please list the legal name and date of birth for any additional children:
To select multiple options on the following question, hold the CTRL key
Does anyone in your family receive assistance from the State of Connecticut?
Self
Spouse
Children
HUSKY Healthcare
Financial Assistance
Not Applicable
If you need to elaborate on any of the above, please include that information here
Submit Form