Name*
Email*
Phone*
Text Okay?* YesNo
Zip Code*
How long are you married?* Less than 1 year1 to 5 years5 to 10 years10+ years
Are you currently separated?* YesNo
Is your spouse aware you are considering divorce / legal separation?* YesNoNot Sure
Do you have minor children together?* YesNo
Do you own a home together?* YesNo
Is your spouse employed?* YesNo
Are you employed?* YesNo
Please share anything else you would like us to know.
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