Intake Questionnaire - Separation Pathways

Welcome to Separation Pathways / Community Hubs for Separating Families. We hope to be able to assist you at this difficult time.

Safety

Separation and divorce are emotionally stressful events. Tensions can run high and there may be threats and abusive behavior that may not have occurred before. Your safety and the safety of your children is our top priority.

If you are concerned about you or your family’s safety, please call either

The Barbra Schlifer Commemorative Clinic at 416-323-9149, or
Luke’s Place at 1-866-516-3116.

You will be asked a number of questions to assess the best next steps for you.

Have you or your partner started a court process?

If you have already started a court process, and need legal assistance, we suggest that you contact either Legal Aid Ontario toll-free at 1‑800‑668‑8258 from Monday to Friday from 8 a.m. to 7:30 p.m. or JusticeNet at info@justicenet.ca .

We are unable to offer you further assistance at this time. CLICK HERE to proceed.
If your circumstances change, please reapply. Thank you!

The questions on this form are intended to support Community Hubs for Separating Families (CHSF) in assisting you. Those with a (*) are required. Only answer others that you are comfortable answering.

If you are looking for a resolution without going to court, then with your safety in mind:

Date / Time *

CHSF Case Number (if available)

Email *

Name *

First

Last

Name to use (if different)

How do you identify (He/She/They)?

Date of Birth (d/m/y)

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Best telephone number to call: *

Alternate telephone number to call:

Best time of day to call: *

Is it safe to leave a message? *

Are you just starting to gather information about separating?

For more information on separating, see the free Family Law Portal. www.familylawportal.com

Are you and your partner still living in the same home? *

Date of marriage or cohabitation (d/m/y) *

Have you separated? *

If yes, date of separation? (d/m/y)

The separation was initiated by:

Me
My partner
Both of us

Are you in a new relationship?

New spouse or partner's name

First

Last

Does your spouse/partner have a new relationship?

*Children: Please list the names and birth dates of the children in this family:

Do you have children?

Name of child #1

Birthdate of child #1

Name of child #2

Birthdate of child #2

Name of child #3

Birthdate of child #3

Name of child #4

Birthdate of child #4

What are you most concerned about? Check all that apply:

Safety concerns – for yourself, children, pets, or others
Parenting Plan - Parenting responsibilities, decision-making, time with children, children’s well-being,
Emotional adjustment to separation/divorce - You, your spouse/partner, children
Financial Issues - Child and/or Spousal support, property division, budgeting
Housing and Relocation
Mental Health, Addictions
Other: For example: Immigration, Retraining, Language

Please specify:

Checkboxes

Yes – I grant permission for Separation Pathways to share my responses with Family Professional Service providers involved in my case.

** Separation Pathways would like to share your information with Family Professional Service Providers working with us. By choosing “Yes” below you are permitting Separation Pathways to share your information electronically with these partners involved in your case.