{"id":4796,"date":"2020-06-08T22:20:01","date_gmt":"2020-06-09T02:20:01","guid":{"rendered":"https:\/\/mediationcentreontario.com\/formulaire-dinformation-sur-la-mediation\/"},"modified":"2024-03-28T18:47:57","modified_gmt":"2024-03-28T22:47:57","slug":"formulaire-dinformation-sur-la-mediation","status":"publish","type":"page","link":"https:\/\/mediationcentreontario.com\/fr\/formulaire-dinformation-sur-la-mediation\/","title":{"rendered":"Formulaire d&rsquo;information sur la m\u00e9diation"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4796\" class=\"elementor elementor-4796 elementor-448\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-cbe34b4 e-flex e-con-boxed e-con e-parent\" data-id=\"cbe34b4\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b3eb5f2 elementor-widget elementor-widget-text-editor\" data-id=\"b3eb5f2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 24-04-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<h1 style=\"text-align: center;\">Formulaire d&rsquo;information sur la m\u00e9diation<\/h1>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3e2ad4c elementor-widget elementor-widget-text-editor\" data-id=\"3e2ad4c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>Veuillez prendre quelques instants pour remplir ce formulaire d&rsquo;information priv\u00e9 et confidentiel. Il s&rsquo;agit de la premi\u00e8re \u00e9tape de la proc\u00e9dure de m\u00e9diation confidentielle. La proc\u00e9dure ne peut commencer que lorsque nous avons re\u00e7u les formulaires d&rsquo;information des deux parties. Les services de m\u00e9ditation sont disponibles en personne et \u00e0 distance par le biais de la technologie pour tous les sites.<\/p>\n<p>Une fois que nous aurons re\u00e7u les formulaires d&rsquo;information des deux parties, le m\u00e9diateur assign\u00e9 \u00e0 votre affaire vous contactera individuellement pour organiser vos r\u00e9unions d&rsquo;accueil confidentielles. Ces r\u00e9unions sont gratuites. Au cours des r\u00e9unions d&rsquo;accueil, le m\u00e9diateur \u00e9valuera si votre affaire se pr\u00eate \u00e0 la m\u00e9diation. Certains cas peuvent ne pas se pr\u00eater \u00e0 la m\u00e9diation.<\/p>\n<p>Si vous avez une date d&rsquo;audience et\/ou un num\u00e9ro de dossier judiciaire, la m\u00e9diation sur place vous sera propos\u00e9e gratuitement pour les affaires qui peuvent \u00eatre trait\u00e9es en deux heures ou moins. Si vous n&rsquo;avez pas de date d&rsquo;audience et\/ou si vous avez un num\u00e9ro de dossier judiciaire, le minist\u00e8re du Procureur g\u00e9n\u00e9ral subventionne les frais de m\u00e9diation familiale pour la m\u00e9diation hors site. Ces frais sont factur\u00e9s en fonction des revenus de chaque personne. Cliquez ici pour conna\u00eetre le <span style=\"color: #000080;\"><a style=\"color: #000080;\" href=\"https:\/\/mediationcentreontario.com\/wp-content\/uploads\/2021\/05\/fees-schedule-1.pdf\"><u>bar\u00e8me des frais<\/u><\/a><\/span>.<\/p>\n<p>Nous encourageons tous les clients \u00e0 obtenir des conseils juridiques avant, pendant et apr\u00e8s toute m\u00e9diation.<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-624f16d e-flex e-con-boxed e-con e-child\" data-id=\"624f16d\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-20be3ba elementor-widget elementor-widget-wpforms\" data-id=\"20be3ba\" data-element_type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-447\"><form id=\"wpforms-form-447\" class=\"wpforms-validate wpforms-form\" data-formid=\"447\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/4796\" data-token=\"2ab7ef25d7c17dd3b6d5b564b0676f41\" data-token-time=\"1779672130\" autocomplete=\"off\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#72b239\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">\u00c9tape <span class=\"wpforms-page-indicator-steps-current\">1<\/span> sur 10<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:10%;background-color:#72b239\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-447-field_295-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"295\"><\/div><div id=\"wpforms-447-field_308-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"308\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_293-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"293\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_293\">Today&#039;s Date <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-447-field_293\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"1\" data-input=\"true\" name=\"wpforms[fields][293][date]\" required><a title=\"Effacer la date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_313-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"313\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_313\">Court Location: <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-447-field_313\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][313]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>--- Please Choose ---<\/option><option value=\"Chatham\" >Chatham<\/option><option value=\"Goderich\" >Goderich<\/option><option value=\"London\" >London<\/option><option value=\"Owen Sound\" >Owen Sound<\/option><option value=\"Sarnia\" >Sarnia<\/option><option value=\"Stratford\" >Stratford<\/option><option value=\"St. Thomas\" >St. Thomas<\/option><option value=\"Walkerton\" >Walkerton<\/option><option value=\"Windsor\" >Windsor<\/option><option value=\"Woodstock\" >Woodstock<\/option><\/select><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_235-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-first wpforms-field-select-style-classic\" data-field-id=\"235\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_235\">Referred To Mediation by:<\/label><select id=\"wpforms-447-field_235\" class=\"wpforms-field-medium\" name=\"wpforms[fields][235]\"><option value=\"Please Choose\" >Please Choose<\/option><option value=\"Advice \/ Duty Counsel\" >Advice \/ Duty Counsel<\/option><option value=\"CAS\" >CAS<\/option><option value=\"Counsel\" >Counsel<\/option><option value=\"Court\" >Court<\/option><option value=\"Court Support Worker\" >Court Support Worker<\/option><option value=\"Dispute Resolution Officer (DRO)\" >Dispute Resolution Officer (DRO)<\/option><option value=\"Family \/ Friends\" >Family \/ Friends<\/option><option value=\"First Appearance Clerk\" >First Appearance Clerk<\/option><option value=\"FLIC\" >FLIC<\/option><option value=\"FRO\" >FRO<\/option><option value=\"Internet \/ Web Search\" >Internet \/ Web Search<\/option><option value=\"IRC\" >IRC<\/option><option value=\"Judge\" >Judge<\/option><option value=\"LAO Call Centre\" >LAO Call Centre<\/option><option value=\"MIP\" >MIP<\/option><option value=\"On-site Mediator\" >On-site Mediator<\/option><option value=\"Off-site Mediator\" >Off-site Mediator<\/option><option value=\"OW \/ ODSP\" >OW \/ ODSP<\/option><option value=\"Self\"  selected='selected'>Self<\/option><\/select><\/div><div id=\"wpforms-447-field_309-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"309\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_299-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"299\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_299\">Are you in court today? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_299\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_299_1\" name=\"wpforms[fields][299]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_299_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_299_2\" name=\"wpforms[fields][299]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_299_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_300-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"300\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_300\">Who is your mediator? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-447-field_300\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][300]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>--- Please Choose ---<\/option><option value=\"anesbitt@mediationcentreontario.com\" >ALLISON NESBITT<\/option><option value=\"abourassa@mediationcentreontario.com\" >AMBER BOURASSA<\/option><option value=\"bguslits@mediationcentreontario.com\" >BAYLY GUSLITS<\/option><option value=\"bwaterton@mediationcentreontario.com\" >BELLA WATERTON<\/option><option value=\"bmuxlow@mediationcentreontario.com\" >BLAKE MUXLOW<\/option><option value=\"bbecker@mediationcentreontario.com\" >BREANNE BECKER<\/option><option value=\"cparrack@mediationcentreontario.com\" >CANDACE PARRACK<\/option><option value=\"cbrown@mediationcentreontario.com\" >CAROLYN BROWN<\/option><option value=\"cwentworth@mediationcentreontario.com\" >CATHERINE WENTWORTH<\/option><option value=\"cvansinterndick@mediationcentreontario.com\" >CATHRIN VAN SINTERN-DICK<\/option><option value=\"dcranker@mediationcentreontario.com\" >DANA CRANKER<\/option><option value=\"dmelville@mediationcentreontario.com\" >DAWN MELVILLE<\/option><option value=\"dsearle@mediationcentreontario.com\" >DOUG SEARLE<\/option><option value=\"esamli@mediationcentreontario.com\" >ESRA SAMLI<\/option><option value=\"jrunstedler@mediationcentreontario.com\" >JENNIFER RUNSTEDLER<\/option><option value=\"jlubrick@mediationcentreontario.com\" >JESSICA LUBRICK<\/option><option value=\"jdoxtdator@mediationcentreontario.com\" >JIM DOXTDATOR<\/option><option value=\"jkellybarrera@mediationcentreontario.com\" >JOHNETTE KELLY-BARRERA<\/option><option value=\"jdasilva@mediationcentreontario.com\" >JUDITH DASILVA<\/option><option value=\"lferguson@mediationcentreontario.com\" >LAURA FERGUSON<\/option><option value=\"lgonzalez@mediationcentreontario.com\" >LYDIA GONZALEZ<\/option><option value=\"msteer@mediationcentreontario.com\" >MEGHAN STEER<\/option><option value=\"pporodo@mediationcentreontario.com\" >PAMELA PORODO<\/option><option value=\"pmontgomery@mediationcentreontario.com\" >PHOEBE MONTGOMERY<\/option><option value=\"pasthana@mediationcentreontario.com\" >PREETI ASTHANA<\/option><option value=\"rmustafa@mediationcentreontario.com\" >ROLA MUSTAFA<\/option><option value=\"sokojie@mediationcentreontario.com\" >STEPHANIE OKOJIE<\/option><option value=\"thainsworth@mediationcentreontario.com\" >TERRY HAINSWORTH<\/option><option value=\"pwright@mediationcentreontario.com\" >TRISHA WRIGHT<\/option><option value=\"zwilson@mediationcentreontario.com\" >ZACH WILSON<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_302-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"302\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_302\">Do you have a court order? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_302\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_302_1\" name=\"wpforms[fields][302]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_302_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_302_2\" name=\"wpforms[fields][302]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_302_2\">No<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_303-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"303\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_303\">Have you or the other party filed or been served with a Form 8A \/ Form 8 (Application), a Motion to Change (Form 15), or a court order in Family Court? * <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_303\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_303_1\" name=\"wpforms[fields][303]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_303_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_303_2\" name=\"wpforms[fields][303]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_303_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_304-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"304\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_304\">If yes, are you the Applicant or the Respondent? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_304\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_304_1\" name=\"wpforms[fields][304]\" value=\"Applicant\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_304_1\">Applicant<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_304_2\" name=\"wpforms[fields][304]\" value=\"Respondent\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_304_2\">Respondent<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_304_3\" name=\"wpforms[fields][304]\" value=\"Neither\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_304_3\">Neither<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_311-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"311\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_3\">What is your court file number?<\/label><input type=\"text\" id=\"wpforms-447-field_3\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"3\" data-text-limit=\"15\" name=\"wpforms[fields][3]\" autocomplete=\"nope\" maxlength=\"15\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_305-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"305\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_305\">When is your next court date?<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-447-field_305\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"1\" data-input=\"true\" name=\"wpforms[fields][305][date]\" ><a title=\"Effacer la date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_312-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"312\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_306-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"306\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_306\">Has the judge ordered you to attend intakes or mediation? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_306\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_306_1\" name=\"wpforms[fields][306]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_306_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_306_2\" name=\"wpforms[fields][306]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_306_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_306_3\" name=\"wpforms[fields][306]\" value=\"I Don&#039;t Know\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_306_3\">I Don't Know<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_307-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"307\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_307\">Do you prefer virtual (Zoom) or in-person meetings? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_307\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_307_1\" name=\"wpforms[fields][307]\" value=\"Virtual (Zoom)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_307_1\">Virtual (Zoom)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_307_2\" name=\"wpforms[fields][307]\" value=\"In-Person\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_307_2\">In-Person<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_294-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"294\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"447\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-447-field_8-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"8\"><h3 id=\"wpforms-447-field_8\">CLIENT INFORMATION<\/h3><\/div><div id=\"wpforms-447-field_314-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"314\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_10\">Your Full Legal Name: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_10\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"10\" data-text-limit=\"35\" name=\"wpforms[fields][10]\" autocomplete=\"nope\" maxlength=\"35\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_458-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"458\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_458\">Date of Birth: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_458\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"458\" data-text-limit=\"25\" name=\"wpforms[fields][458]\" autocomplete=\"nope\" maxlength=\"25\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_12-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_12\">Age: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-447-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" autocomplete=\"nope\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_328-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"328\"><div id=\"wpforms-447-field_328\"><div style=\"min-height: 20px\"><\/div><\/div><\/div><div id=\"wpforms-447-field_315-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"315\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-447-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_13\">Current Address: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_13\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"13\" data-text-limit=\"60\" name=\"wpforms[fields][13]\" autocomplete=\"nope\" maxlength=\"60\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_14\">Apt\/ Unit:<\/label><input type=\"text\" id=\"wpforms-447-field_14\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"14\" data-text-limit=\"7\" name=\"wpforms[fields][14]\" autocomplete=\"nope\" maxlength=\"7\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_316-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"316\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_16\">City: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_16\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"16\" data-text-limit=\"35\" name=\"wpforms[fields][16]\" autocomplete=\"nope\" maxlength=\"35\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-447-field_297-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"297\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_297\">Province<\/label><select id=\"wpforms-447-field_297\" class=\"wpforms-field-medium\" name=\"wpforms[fields][297]\"><option value=\"Ontario\" >Ontario<\/option><option value=\"Alberta\" >Alberta<\/option><option value=\"British Columbia\" >British Columbia<\/option><option value=\"Manitoba\" >Manitoba<\/option><option value=\"New Brunswick\" >New Brunswick<\/option><option value=\"Newfoundland and Labrador\" >Newfoundland and Labrador<\/option><option value=\"Northwest Territories\" >Northwest Territories<\/option><option value=\"Nova Scotia\" >Nova Scotia<\/option><option value=\"Nunavut\" >Nunavut<\/option><option value=\"Ontario\" >Ontario<\/option><option value=\"Prince Edward Island\" >Prince Edward Island<\/option><option value=\"Quebec\" >Quebec<\/option><option value=\"Saskatchewan\" >Saskatchewan<\/option><option value=\"Yukon\" >Yukon<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-447-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_17\">Postal Code:<\/label><input type=\"text\" id=\"wpforms-447-field_17\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"17\" data-text-limit=\"9\" name=\"wpforms[fields][17]\" autocomplete=\"nope\" maxlength=\"9\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_324-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"324\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_325-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"325\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_325\">Phone (Primary) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-447-field_325\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][325]\" autocomplete=\"nope\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_326-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"326\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_326\">Phone (Alternative)<\/label><input type=\"tel\" id=\"wpforms-447-field_326\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][326]\" autocomplete=\"nope\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_327-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"327\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_327\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-447-field_327\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][327]\" spellcheck=\"false\" autocomplete=\"nope\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_323-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"323\"><div id=\"wpforms-447-field_323\"><div style=\"min-height: 20px\"><\/div><\/div><\/div><div id=\"wpforms-447-field_318-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"318\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_24-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_24\">Employer \/ Source of Income<\/label><input type=\"text\" id=\"wpforms-447-field_24\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"24\" data-text-limit=\"30\" name=\"wpforms[fields][24]\" autocomplete=\"nope\" maxlength=\"30\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_25\">Annual Income $ <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_25\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"25\" data-text-limit=\"10\" name=\"wpforms[fields][25]\" autocomplete=\"nope\" maxlength=\"10\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_319-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"319\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_22\">Lawyer&#039;s Name:<\/label><input type=\"text\" id=\"wpforms-447-field_22\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"22\" data-text-limit=\"30\" name=\"wpforms[fields][22]\" autocomplete=\"nope\" maxlength=\"30\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_23\">Duty Counsel&#039;s Name:<\/label><input type=\"text\" id=\"wpforms-447-field_23\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"23\" data-text-limit=\"30\" name=\"wpforms[fields][23]\" autocomplete=\"nope\" maxlength=\"30\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_329-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"329\"><div id=\"wpforms-447-field_329\"><div style=\"min-height: 20px\"><\/div><\/div><\/div><div id=\"wpforms-447-field_320-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"320\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_331-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"331\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_331\">Language <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_331\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"331\" data-text-limit=\"30\" name=\"wpforms[fields][331]\" autocomplete=\"nope\" maxlength=\"30\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_214-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"214\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_214\">Do you require an interpreter? <\/label><ul id=\"wpforms-447-field_214\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_214_1\" name=\"wpforms[fields][214]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_214_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_214_2\" name=\"wpforms[fields][214]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_214_2\">No<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_330-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"330\"><div id=\"wpforms-447-field_330\"><div style=\"min-height: 20px\"><\/div><\/div><\/div><div id=\"wpforms-447-field_215-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"215\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_215\">Have you visited the Family Law Information Centre (FLIC)<\/label><ul id=\"wpforms-447-field_215\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_215_1\" name=\"wpforms[fields][215]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_215_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_215_2\" name=\"wpforms[fields][215]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_215_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_216-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"216\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_216\">Have you attended the Mandatory Information Program?<\/label><ul id=\"wpforms-447-field_216\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_216_1\" name=\"wpforms[fields][216]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_216_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_216_2\" name=\"wpforms[fields][216]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_216_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_298-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"298\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"2\" data-formid=\"447\" disabled>Previous<\/button><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"2\" data-formid=\"447\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-447-field_33-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"33\"><h3 id=\"wpforms-447-field_33\">OTHER CLIENT DETAILS<\/h3><\/div><div id=\"wpforms-447-field_333-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"333\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_34-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_34\">Other Party&#039;s Full Legal Name: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_34\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"34\" data-text-limit=\"35\" name=\"wpforms[fields][34]\" autocomplete=\"nope\" maxlength=\"35\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-447-field_461-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"461\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_461\">Other Party Date of Birth:<\/label><input type=\"text\" id=\"wpforms-447-field_461\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"461\" data-text-limit=\"25\" name=\"wpforms[fields][461]\" autocomplete=\"nope\" maxlength=\"25\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-447-field_36-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_36\">Other Party&#039;s Age: <\/label><input type=\"number\" id=\"wpforms-447-field_36\" class=\"wpforms-field-medium\" name=\"wpforms[fields][36]\" autocomplete=\"nope\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_342-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"342\"><div id=\"wpforms-447-field_342\"><div style=\"min-height: 20px\"><\/div><\/div><\/div><div id=\"wpforms-447-field_334-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"334\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-447-field_37-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_37\">Other Party&#039;s Current Address:<\/label><input type=\"text\" id=\"wpforms-447-field_37\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"37\" data-text-limit=\"60\" name=\"wpforms[fields][37]\" autocomplete=\"nope\" maxlength=\"60\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_38-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_38\">Other party&#039;s Apt\/ Unit:<\/label><input type=\"text\" id=\"wpforms-447-field_38\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"38\" data-text-limit=\"7\" name=\"wpforms[fields][38]\" autocomplete=\"nope\" maxlength=\"7\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_335-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"335\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_39-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_39\">Other Party&#039;s City:<\/label><input type=\"text\" id=\"wpforms-447-field_39\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"39\" data-text-limit=\"35\" name=\"wpforms[fields][39]\" autocomplete=\"nope\" maxlength=\"35\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-447-field_336-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"336\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_336\">Other Party&#039;s Province<\/label><select id=\"wpforms-447-field_336\" class=\"wpforms-field-medium\" name=\"wpforms[fields][336]\"><option value=\"Ontario\" >Ontario<\/option><option value=\"Alberta\" >Alberta<\/option><option value=\"British Columbia\" >British Columbia<\/option><option value=\"Manitoba\" >Manitoba<\/option><option value=\"New Brunswick\" >New Brunswick<\/option><option value=\"Newfoundland and Labrador\" >Newfoundland and Labrador<\/option><option value=\"Northwest Territories\" >Northwest Territories<\/option><option value=\"Nova Scotia\" >Nova Scotia<\/option><option value=\"Nunavut\" >Nunavut<\/option><option value=\"Ontario\" >Ontario<\/option><option value=\"Prince Edward Island\" >Prince Edward Island<\/option><option value=\"Quebec\" >Quebec<\/option><option value=\"Saskatchewan\" >Saskatchewan<\/option><option value=\"Yukon\" >Yukon<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-447-field_40-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_40\">Other Party&#039;s Postal Code:<\/label><input type=\"text\" id=\"wpforms-447-field_40\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"40\" data-text-limit=\"9\" name=\"wpforms[fields][40]\" autocomplete=\"nope\" maxlength=\"9\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_343-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"343\"><div id=\"wpforms-447-field_343\"><div style=\"min-height: 20px\"><\/div><\/div><\/div><div id=\"wpforms-447-field_337-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"337\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_41-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_41\">Other Party Phone (Primary) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-447-field_41\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][41]\" autocomplete=\"nope\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_42-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_42\">Other Party&#039;s Phone (Alternative)<\/label><input type=\"tel\" id=\"wpforms-447-field_42\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][42]\" autocomplete=\"nope\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_44-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_44\">Other Party&#039;s Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-447-field_44\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][44]\" spellcheck=\"false\" autocomplete=\"nope\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_344-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"344\"><div id=\"wpforms-447-field_344\"><div style=\"min-height: 20px\"><\/div><\/div><\/div><div id=\"wpforms-447-field_338-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"338\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-447-field_45-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_45\">Other Party&#039;s Employer \/ Source of Income<\/label><input type=\"text\" id=\"wpforms-447-field_45\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"45\" data-text-limit=\"30\" name=\"wpforms[fields][45]\" autocomplete=\"nope\" maxlength=\"30\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_46-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_46\">Other Party&#039;s Annual Income $ <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_46\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"46\" data-text-limit=\"10\" name=\"wpforms[fields][46]\" autocomplete=\"nope\" maxlength=\"10\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_339-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"339\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout (copy)<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_340-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"340\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_340\">Other Party&#039;s Lawyer&#039;s Name:<\/label><input type=\"text\" id=\"wpforms-447-field_340\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"340\" data-text-limit=\"30\" name=\"wpforms[fields][340]\" autocomplete=\"nope\" maxlength=\"30\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_341-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"341\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_341\">Other Party&#039;s Duty Counsel&#039;s Name:<\/label><input type=\"text\" id=\"wpforms-447-field_341\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"341\" data-text-limit=\"30\" name=\"wpforms[fields][341]\" autocomplete=\"nope\" maxlength=\"30\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_332-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"332\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"3\" data-formid=\"447\" disabled>Previous<\/button><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"3\" data-formid=\"447\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-447-field_47-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"47\"><h3 id=\"wpforms-447-field_47\">RELATIONSHIP INFORMATION<\/h3><\/div><div id=\"wpforms-447-field_347-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"347\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_462-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"462\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_462\">How long did you date (years\/months)?<\/label><input type=\"text\" id=\"wpforms-447-field_462\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"462\" data-text-limit=\"25\" name=\"wpforms[fields][462]\" placeholder=\"Years - Months\" autocomplete=\"nope\" maxlength=\"25\" ><\/div><div id=\"wpforms-447-field_48-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"48\"><div id=\"wpforms-447-field_48\">How long did you date?<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><\/div><\/div><div id=\"wpforms-447-field_348-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"348\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_217-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"217\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_217\">Did you live together? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_217\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_217_1\" name=\"wpforms[fields][217]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_217_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_217_2\" name=\"wpforms[fields][217]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_217_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_291-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"291\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_291\">Were you legally married? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_291\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_291_1\" name=\"wpforms[fields][291]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_291_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_291_2\" name=\"wpforms[fields][291]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_291_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_292-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"292\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_292\">What is your date of separation?<\/label><input type=\"text\" id=\"wpforms-447-field_292\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"292\" data-text-limit=\"20\" name=\"wpforms[fields][292]\" autocomplete=\"nope\" maxlength=\"20\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_56-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_56\">Who made the decision to separate?<\/label><input type=\"text\" id=\"wpforms-447-field_56\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"56\" data-text-limit=\"100\" name=\"wpforms[fields][56]\" autocomplete=\"nope\" maxlength=\"100\" ><\/div><div id=\"wpforms-447-field_350-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"350\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_349-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"349\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_349\">Are you or have you completed marriage\/couples counselling?<\/label><ul id=\"wpforms-447-field_349\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_349_1\" name=\"wpforms[fields][349]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_349_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_349_2\" name=\"wpforms[fields][349]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_349_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_352-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"352\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_352\">Do you have a signed separation agreement?<\/label><ul id=\"wpforms-447-field_352\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_352_1\" name=\"wpforms[fields][352]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_352_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_352_2\" name=\"wpforms[fields][352]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_352_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_354-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"354\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_354\">Have either of you left the family home?<\/label><ul id=\"wpforms-447-field_354\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_354_1\" name=\"wpforms[fields][354]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_354_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_354_2\" name=\"wpforms[fields][354]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_354_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_351-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"351\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_351\">Do you have any interest in reconciliation?<\/label><ul id=\"wpforms-447-field_351\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_351_1\" name=\"wpforms[fields][351]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_351_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_351_2\" name=\"wpforms[fields][351]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_351_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_353-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"353\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_353\">Do you have a prenuptial \/ marriage contract?<\/label><ul id=\"wpforms-447-field_353\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_353_1\" name=\"wpforms[fields][353]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_353_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_353_2\" name=\"wpforms[fields][353]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_353_2\">No<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_64-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"64\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_64\">List any reason which contributed to your separation:<\/label><textarea id=\"wpforms-447-field_64\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"64\" data-text-limit=\"100\" name=\"wpforms[fields][64]\" maxlength=\"100\" ><\/textarea><\/div><div id=\"wpforms-447-field_355-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"355\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"4\" data-formid=\"447\" disabled>Previous<\/button><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"4\" data-formid=\"447\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5  \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-447-field_65-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"65\"><h3 id=\"wpforms-447-field_65\">CHILDREN:<\/h3><\/div><div id=\"wpforms-447-field_221-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"221\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_221\">Are there children in the relationship? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_221\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_221_1\" name=\"wpforms[fields][221]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_221_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_221_2\" name=\"wpforms[fields][221]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_221_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_367-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"367\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-447-field_368-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"368\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_368\">1. Child Name:<\/label><input type=\"text\" id=\"wpforms-447-field_368\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"368\" data-text-limit=\"75\" name=\"wpforms[fields][368]\" autocomplete=\"nope\" maxlength=\"75\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_485-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"485\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_485\">1. Date Of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_485\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][485]\" autocomplete=\"nope\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_370-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"370\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-447-field_371-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"371\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_371\">2. Child Name:<\/label><input type=\"text\" id=\"wpforms-447-field_371\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"371\" data-text-limit=\"75\" name=\"wpforms[fields][371]\" autocomplete=\"nope\" maxlength=\"75\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_486-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"486\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_486\">2. Date Of Birth  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_486\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][486]\" autocomplete=\"nope\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_373-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"373\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-447-field_374-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"374\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_374\">3. Child Name:<\/label><input type=\"text\" id=\"wpforms-447-field_374\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"374\" data-text-limit=\"75\" name=\"wpforms[fields][374]\" autocomplete=\"nope\" maxlength=\"75\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_487-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"487\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_487\">3. Date Of Birth   <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_487\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][487]\" autocomplete=\"nope\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_376-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"376\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-447-field_488-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"488\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_488\">4. Child Name: <\/label><input type=\"text\" id=\"wpforms-447-field_488\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"488\" data-text-limit=\"75\" name=\"wpforms[fields][488]\" autocomplete=\"nope\" maxlength=\"75\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_489-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"489\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_489\">4. Date Of Birth    <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_489\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][489]\" autocomplete=\"nope\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_379-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"379\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_379\">Add if required:<\/label><textarea id=\"wpforms-447-field_379\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"379\" data-text-limit=\"85\" name=\"wpforms[fields][379]\" maxlength=\"85\" ><\/textarea><\/div><div id=\"wpforms-447-field_460-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"460\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_460\">Are you in a new relationship?<\/label><ul id=\"wpforms-447-field_460\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_460_1\" name=\"wpforms[fields][460]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_460_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_460_2\" name=\"wpforms[fields][460]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_460_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_480-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"480\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_480\">Do you have children from another relationship?<\/label><ul id=\"wpforms-447-field_480\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_480_1\" name=\"wpforms[fields][480]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_480_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_480_2\" name=\"wpforms[fields][480]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_480_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_381-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"381\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-447-field_382-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"382\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_382\">1b. Child Name:<\/label><input type=\"text\" id=\"wpforms-447-field_382\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"382\" data-text-limit=\"75\" name=\"wpforms[fields][382]\" autocomplete=\"nope\" maxlength=\"75\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_490-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"490\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_490\">1b. Date of Birth  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_490\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][490]\" autocomplete=\"nope\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_384-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"384\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-447-field_385-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"385\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_385\">2b. Child Name:<\/label><input type=\"text\" id=\"wpforms-447-field_385\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"385\" data-text-limit=\"75\" name=\"wpforms[fields][385]\" autocomplete=\"nope\" maxlength=\"75\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_491-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"491\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_491\">2b. Date of Birth   <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_491\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][491]\" autocomplete=\"nope\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_387-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"387\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-447-field_388-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"388\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_388\">3b. Child Name:<\/label><input type=\"text\" id=\"wpforms-447-field_388\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"388\" data-text-limit=\"75\" name=\"wpforms[fields][388]\" autocomplete=\"nope\" maxlength=\"75\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_492-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"492\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_492\">3b. Date of Birth  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_492\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][492]\" autocomplete=\"nope\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_493-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"493\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout (copy)<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-67-33\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-447-field_494-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"494\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_494\">4b. Child Name: <\/label><input type=\"text\" id=\"wpforms-447-field_494\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"494\" data-text-limit=\"75\" name=\"wpforms[fields][494]\" autocomplete=\"nope\" maxlength=\"75\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-447-field_495-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"495\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_495\">4b. Date of Birth   <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_495\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][495]\" autocomplete=\"nope\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_397-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"397\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_397\">Add if required:<\/label><textarea id=\"wpforms-447-field_397\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"397\" data-text-limit=\"85\" name=\"wpforms[fields][397]\" maxlength=\"85\" ><\/textarea><\/div><div id=\"wpforms-447-field_356-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"356\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"5\" data-formid=\"447\" disabled>Previous<\/button><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"5\" data-formid=\"447\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-6  \" data-page=\"6\" style=\"display:none;\"><div id=\"wpforms-447-field_133-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"133\"><h3 id=\"wpforms-447-field_133\">MEDIATION INTEREST:<\/h3><\/div><div id=\"wpforms-447-field_230-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"230\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_230\">Are you entering into mediation voluntarily? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_230\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_230_1\" name=\"wpforms[fields][230]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_230_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_230_2\" name=\"wpforms[fields][230]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_230_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_398-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"398\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_398\">Do you have any concerns about mediating with your former partner? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_398\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_398_1\" name=\"wpforms[fields][398]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_398_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_398_2\" name=\"wpforms[fields][398]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_398_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_136-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"136\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_136\">If yes, please explain:<\/label><textarea id=\"wpforms-447-field_136\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"136\" data-text-limit=\"80\" name=\"wpforms[fields][136]\" maxlength=\"80\" ><\/textarea><\/div><div id=\"wpforms-447-field_399-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-id=\"399\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_399\">Issues to be mediated (check all that apply):<\/label><ul id=\"wpforms-447-field_399\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_399_1\" name=\"wpforms[fields][399][]\" value=\"Parental Decision Making\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_399_1\">Parental Decision Making<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_399_2\" name=\"wpforms[fields][399][]\" value=\"Extraordinary Expenses\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_399_2\">Extraordinary Expenses<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_399_3\" name=\"wpforms[fields][399][]\" value=\"Property \/ Financial Issues\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_399_3\">Property \/ Financial Issues<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_399_4\" name=\"wpforms[fields][399][]\" value=\"Access \/ Parenting Time\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_399_4\">Access \/ Parenting Time<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_399_5\" name=\"wpforms[fields][399][]\" value=\"Spousal \/ Parent Support\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_399_5\">Spousal \/ Parent Support<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_399_6\" name=\"wpforms[fields][399][]\" value=\"Travel\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_399_6\">Travel<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_399_7\" name=\"wpforms[fields][399][]\" value=\"Child Support\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_399_7\">Child Support<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_399_8\" name=\"wpforms[fields][399][]\" value=\"Mobility\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_399_8\">Mobility<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_399_9\" name=\"wpforms[fields][399][]\" value=\"Other\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_399_9\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_400-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"400\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"6\" data-formid=\"447\" disabled>Previous<\/button><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"6\" data-formid=\"447\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-7  \" data-page=\"7\" style=\"display:none;\"><div id=\"wpforms-447-field_158-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"158\"><h3 id=\"wpforms-447-field_158\">LEGAL AND COURT PROCEEDINGS<\/h3><\/div><div id=\"wpforms-447-field_402-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"402\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_402\">Has there been a court case in the past between you and the other party? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_402\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_402_1\" name=\"wpforms[fields][402]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_402_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_402_2\" name=\"wpforms[fields][402]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_402_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_403-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"403\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_403\">Have you requested a protection order due to abuse? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_403\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_403_1\" name=\"wpforms[fields][403]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_403_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_403_2\" name=\"wpforms[fields][403]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_403_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_404-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"404\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_404\">Has the other party been convicted of any domestic abuse charges? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_404\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_404_1\" name=\"wpforms[fields][404]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_404_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_404_2\" name=\"wpforms[fields][404]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_404_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_401-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"401\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"7\" data-formid=\"447\" disabled>Previous<\/button><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"7\" data-formid=\"447\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-8  \" data-page=\"8\" style=\"display:none;\"><div id=\"wpforms-447-field_167-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"167\"><h3 id=\"wpforms-447-field_167\">EVENTS SIX MONTHS BEFORE AND SIX MONTHS AFTER SEPERATION:<\/h3><div class=\"wpforms-field-description\">Has your former partner done any of the following hurtful acts or behaviours? Please answer YES or\r\nNO for each question. If YES, please check when (before and\/or after separating) and how often.<\/div><\/div><div id=\"wpforms-447-field_412-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"412\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_406-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"406\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_406\">Threatened to come after you if you tried to leave? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_406\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_406_1\" name=\"wpforms[fields][406]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_406_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_406_2\" name=\"wpforms[fields][406]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_406_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_482-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"482\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_482\">When did they threaten to come after you if you tried to leave?<\/label><ul id=\"wpforms-447-field_482\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_482_1\" name=\"wpforms[fields][482][]\" value=\"During last six months prior to separation\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_482_1\">During last six months prior to separation<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_482_2\" name=\"wpforms[fields][482][]\" value=\"Since you emotionally separated\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_482_2\">Since you emotionally separated<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_411-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"411\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_411\">How Often did they Threaten to come after you if you tried to leave??<\/label><input type=\"text\" id=\"wpforms-447-field_411\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"411\" data-text-limit=\"85\" name=\"wpforms[fields][411]\" autocomplete=\"nope\" maxlength=\"85\" ><\/div><div id=\"wpforms-447-field_414-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"414\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_415-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"415\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_415\">Threatened to hurt or kill you? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_415\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_415_1\" name=\"wpforms[fields][415]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_415_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_415_2\" name=\"wpforms[fields][415]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_415_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_483-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"483\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_483\">When did they threaten to hurt or kill you?<\/label><ul id=\"wpforms-447-field_483\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_483_1\" name=\"wpforms[fields][483][]\" value=\"During last six months prior to separation\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_483_1\">During last six months prior to separation<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_483_2\" name=\"wpforms[fields][483][]\" value=\"Since you emotionally separated\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_483_2\">Since you emotionally separated<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_417-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"417\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_417\">How Often did they threaten to hurt or kill you?<\/label><input type=\"text\" id=\"wpforms-447-field_417\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"417\" data-text-limit=\"85\" name=\"wpforms[fields][417]\" autocomplete=\"nope\" maxlength=\"85\" ><\/div><div id=\"wpforms-447-field_418-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"418\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_419-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"419\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_419\">Showed anger by yelling, throwing or breaking things, pounding walls or tables? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_419\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_419_1\" name=\"wpforms[fields][419]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_419_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_419_2\" name=\"wpforms[fields][419]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_419_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_420-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"420\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_420\">When did they show anger by yelling, throwing or breaking things, pounding walls or tables?<\/label><ul id=\"wpforms-447-field_420\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_420_1\" name=\"wpforms[fields][420][]\" value=\"During last six months prior to separation\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_420_1\">During last six months prior to separation<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_420_2\" name=\"wpforms[fields][420][]\" value=\"Since you emotionally separated\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_420_2\">Since you emotionally separated<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_421-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"421\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_421\">How Often did they show anger by yelling, throwing or breaking things, pounding walls or tables?<\/label><input type=\"text\" id=\"wpforms-447-field_421\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"421\" data-text-limit=\"85\" name=\"wpforms[fields][421]\" autocomplete=\"nope\" maxlength=\"85\" ><\/div><div id=\"wpforms-447-field_422-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"422\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_423-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"423\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_423\">Put you down, called you names, swore at you, insulted you in public? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_423\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_423_1\" name=\"wpforms[fields][423]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_423_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_423_2\" name=\"wpforms[fields][423]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_423_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_424-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"424\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_424\">When did they put you down, called you names, swore at you, insulted you in public?<\/label><ul id=\"wpforms-447-field_424\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_424_1\" name=\"wpforms[fields][424][]\" value=\"During last six months prior to separation\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_424_1\">During last six months prior to separation<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_424_2\" name=\"wpforms[fields][424][]\" value=\"Since you emotionally separated\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_424_2\">Since you emotionally separated<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_425-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"425\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_425\">How Often did they put you down, call you names, swear at you, insult you in public?<\/label><input type=\"text\" id=\"wpforms-447-field_425\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"425\" data-text-limit=\"85\" name=\"wpforms[fields][425]\" autocomplete=\"nope\" maxlength=\"85\" ><\/div><div id=\"wpforms-447-field_426-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"426\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_427-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"427\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_427\">Showed excessive jealousy by constantly questioning, accusing, or threatening you? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_427\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_427_1\" name=\"wpforms[fields][427]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_427_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_427_2\" name=\"wpforms[fields][427]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_427_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_428-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"428\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_428\">When did they show excessive jealousy by constantly questioning, accusing, or threatening you?<\/label><ul id=\"wpforms-447-field_428\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_428_1\" name=\"wpforms[fields][428][]\" value=\"During last six months prior to separation\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_428_1\">During last six months prior to separation<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_428_2\" name=\"wpforms[fields][428][]\" value=\"Since you emotionally separated\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_428_2\">Since you emotionally separated<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_429-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"429\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_429\">How Often did they show excessive jealousy by constantly questioning, accusing, or threatening you?<\/label><input type=\"text\" id=\"wpforms-447-field_429\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"429\" data-text-limit=\"85\" name=\"wpforms[fields][429]\" autocomplete=\"nope\" maxlength=\"85\" ><\/div><div id=\"wpforms-447-field_430-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"430\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_431-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"431\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_431\">Pressured you to have sex? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_431\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_431_1\" name=\"wpforms[fields][431]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_431_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_431_2\" name=\"wpforms[fields][431]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_431_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_432-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"432\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_432\">When did they pressure you to have sex?<\/label><ul id=\"wpforms-447-field_432\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_432_1\" name=\"wpforms[fields][432][]\" value=\"During last six months prior to separation\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_432_1\">During last six months prior to separation<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_432_2\" name=\"wpforms[fields][432][]\" value=\"Since you emotionally separated\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_432_2\">Since you emotionally separated<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_433-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"433\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_433\">How Often did they pressure you to have sex?<\/label><input type=\"text\" id=\"wpforms-447-field_433\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"433\" data-text-limit=\"85\" name=\"wpforms[fields][433]\" autocomplete=\"nope\" maxlength=\"85\" ><\/div><div id=\"wpforms-447-field_434-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"434\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_435-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"435\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_435\">Slapped, kicked or pulled your hair, smothered you, twisted your arm, pinned you down, used force to put you out of the house? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_435\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_435_1\" name=\"wpforms[fields][435]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_435_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_435_2\" name=\"wpforms[fields][435]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_435_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_436-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"436\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_436\">When did they Slap, kick or pull your hair, smother you, twist your arm, pin you down, use force to put you out of the house?<\/label><ul id=\"wpforms-447-field_436\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_436_1\" name=\"wpforms[fields][436][]\" value=\"During last six months prior to separation\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_436_1\">During last six months prior to separation<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_436_2\" name=\"wpforms[fields][436][]\" value=\"Since you emotionally separated\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_436_2\">Since you emotionally separated<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_437-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"437\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_437\">How Often did they Slap, kick or pull your hair, smother you, twist your arm, pin you down, use force to put you out of the house?<\/label><input type=\"text\" id=\"wpforms-447-field_437\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"437\" data-text-limit=\"85\" name=\"wpforms[fields][437]\" autocomplete=\"nope\" maxlength=\"85\" ><\/div><div id=\"wpforms-447-field_438-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"438\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_439-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"439\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_439\">Choked or strangled you, punched you with a fist, kicked you, hit you with something? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_439\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_439_1\" name=\"wpforms[fields][439]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_439_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_439_2\" name=\"wpforms[fields][439]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_439_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_440-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"440\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_440\">When did they choke or strangle you, punch you with a fist, kick you, hit you with something?<\/label><ul id=\"wpforms-447-field_440\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_440_1\" name=\"wpforms[fields][440][]\" value=\"During last six months prior to separation\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_440_1\">During last six months prior to separation<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_440_2\" name=\"wpforms[fields][440][]\" value=\"Since you emotionally separated\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_440_2\">Since you emotionally separated<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_441-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"441\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_441\">How Often did they choke or strangle you, punch you with a fist, kick you, hit you with something?<\/label><input type=\"text\" id=\"wpforms-447-field_441\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"441\" data-text-limit=\"85\" name=\"wpforms[fields][441]\" autocomplete=\"nope\" maxlength=\"85\" ><\/div><div id=\"wpforms-447-field_442-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"442\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_443-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"443\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_443\">Threatened you with a knife, gun or other weapon? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_443\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_443_1\" name=\"wpforms[fields][443]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_443_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_443_2\" name=\"wpforms[fields][443]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_443_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_444-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"444\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_444\">When did they threaten you with a knife, gun or other weapon?<\/label><ul id=\"wpforms-447-field_444\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_444_1\" name=\"wpforms[fields][444][]\" value=\"During last six months prior to separation\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_444_1\">During last six months prior to separation<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_444_2\" name=\"wpforms[fields][444][]\" value=\"Since you emotionally separated\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_444_2\">Since you emotionally separated<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_445-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"445\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_445\">How Often did they threaten you with a knife, gun or other weapon?<\/label><input type=\"text\" id=\"wpforms-447-field_445\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"445\" data-text-limit=\"85\" name=\"wpforms[fields][445]\" autocomplete=\"nope\" maxlength=\"85\" ><\/div><div id=\"wpforms-447-field_446-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"446\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_447-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"447\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_447\">Stabbed or shot you or used some other weapon to injure you physically? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_447\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_447_1\" name=\"wpforms[fields][447]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_447_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_447_2\" name=\"wpforms[fields][447]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_447_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_448-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"448\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_448\">When did they Stab or shoot you or use some other weapon to injure you physically?<\/label><ul id=\"wpforms-447-field_448\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_448_1\" name=\"wpforms[fields][448][]\" value=\"During last six months prior to separation\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_448_1\">During last six months prior to separation<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_448_2\" name=\"wpforms[fields][448][]\" value=\"Since you emotionally separated\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_448_2\">Since you emotionally separated<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_449-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"449\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_449\">How Often did they stab or shoot you or use some other weapon to injure you physically?<\/label><input type=\"text\" id=\"wpforms-447-field_449\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"449\" data-text-limit=\"85\" name=\"wpforms[fields][449]\" autocomplete=\"nope\" maxlength=\"85\" ><\/div><div id=\"wpforms-447-field_450-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"450\"><label class=\"wpforms-field-label wpforms-label-hide\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_451-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"451\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_451\">Threatened to hurt you or your children in any way? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_451\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_451_1\" name=\"wpforms[fields][451]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_451_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_451_2\" name=\"wpforms[fields][451]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_451_2\">No<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-447-field_452-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"452\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_452\">When did they threaten to hurt you or your children in any way?<\/label><ul id=\"wpforms-447-field_452\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_452_1\" name=\"wpforms[fields][452][]\" value=\"During last six months prior to separation\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_452_1\">During last six months prior to separation<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-447-field_452_2\" name=\"wpforms[fields][452][]\" value=\"Since you emotionally separated\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_452_2\">Since you emotionally separated<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-447-field_453-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"453\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_453\">How Often did they threaten to hurt you or your children in any way?<\/label><input type=\"text\" id=\"wpforms-447-field_453\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"453\" data-text-limit=\"85\" name=\"wpforms[fields][453]\" autocomplete=\"nope\" maxlength=\"85\" ><\/div><div id=\"wpforms-447-field_413-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"413\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"8\" data-formid=\"447\" disabled>Previous<\/button><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"8\" data-formid=\"447\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-9  \" data-page=\"9\" style=\"display:none;\"><div id=\"wpforms-447-field_192-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"192\"><h3 id=\"wpforms-447-field_192\">RELATIONSHIP CHARACTERISTICS<\/h3><\/div><div id=\"wpforms-447-field_212-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"212\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_212\">When you and your former partner were living together and when you became involved in disagreements or conflicts, how well did you stand up for yourself and state your position, compared to your former partner? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_212\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_212_1\" name=\"wpforms[fields][212]\" value=\"Better\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_212_1\">Better<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_212_2\" name=\"wpforms[fields][212]\" value=\"Equally Well\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_212_2\">Equally Well<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_212_3\" name=\"wpforms[fields][212]\" value=\"Less Well\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_212_3\">Less Well<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_213-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"213\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_213\">At the present time, if you and your former partner became involved in a disagreement or conflicts, how well can you stand up for yourself and state your position, compared to your former partner? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_213\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_213_1\" name=\"wpforms[fields][213]\" value=\"Better\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_213_1\">Better<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_213_2\" name=\"wpforms[fields][213]\" value=\"Equally Well\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_213_2\">Equally Well<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_213_3\" name=\"wpforms[fields][213]\" value=\"Less Well\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_213_3\">Less Well<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_237-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"237\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_237\">Since you separated, has your former partner stalked or harassed you making you feel unsafe? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_237\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_237_1\" name=\"wpforms[fields][237]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_237_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_237_2\" name=\"wpforms[fields][237]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_237_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_238-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"238\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_238\">Since you separated, has your former partner called or messaged you at all hours of the day and night? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_238\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_238_1\" name=\"wpforms[fields][238]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_238_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_238_2\" name=\"wpforms[fields][238]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_238_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_239-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"239\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_239\">Since you separated, has your former partner said hurtful things about you to your children? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_239\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_239_1\" name=\"wpforms[fields][239]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_239_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_239_2\" name=\"wpforms[fields][239]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_239_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_240-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"240\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_240\">In the last six months of your relationship, did your former partner make you ask for money and\/or account for all money you spent? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_240\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_240_1\" name=\"wpforms[fields][240]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_240_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_240_2\" name=\"wpforms[fields][240]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_240_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_241-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"241\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_241\">Have you sought help for yourself as a result of abuse by your former partner? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-447-field_241\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_241_1\" name=\"wpforms[fields][241]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_241_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-447-field_241_2\" name=\"wpforms[fields][241]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-447-field_241_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-447-field_204-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"204\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_204\">Is there anything else you would like us to know? <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-447-field_204\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"204\" data-text-limit=\"100\" name=\"wpforms[fields][204]\" maxlength=\"100\" required><\/textarea><\/div><div id=\"wpforms-447-field_206-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"206\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_206\">If it is unsafe for us to contact you via telephone, please state the best time and way to contact you: <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-447-field_206\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"447\" data-field-id=\"206\" data-text-limit=\"100\" name=\"wpforms[fields][206]\" maxlength=\"100\" required><\/textarea><\/div><div id=\"wpforms-447-field_208-container\" class=\"wpforms-field wpforms-field-html important-notice-agree-bottom\" data-field-id=\"208\"><div id=\"wpforms-447-field_208\"><p><b>I have read and acknowledge the following confidential information disclosure and consent:<\/b><\/p>\r\n\r\n<div style=\"margin-left: 20px; margin-top: 20px\">\r\n  <ol>\r\n    <li>\r\n      The Intake Coordinator, the Mediator and the Parties shall keep confidential all written and verbal information prepared, provided, disclosed, or exchanged during or for the purpose of the mediation.\r\n    <\/li>\r\n    <li>\r\n      Notwithstanding the aforementioned, the Mediator may, at their sole discretion, disclose information about the mediation:\r\n      <ul style=\"list-style-type: none; padding-left: 20px;\">\r\n        <li style=\"list-style: none !important;\">a) To communicate with the Parties, their lawyers or other legal representatives, and third parties retained by a Party, their lawyer, or other legal representative;<\/li>\r\n        <li style=\"list-style: none !important;\">b) Where ordered to do so by law;<\/li>\r\n        <li style=\"list-style: none !important;\">c) Where required to do so by law, including but not limited to obligations to report a child in need of protection; or<\/li>\r\n        <li style=\"list-style: none !important;\">d) Where the information indicates an actual or potential threat to human life or safety.<br \/>\r\n\r\n<br \/><strong>I agree to the confidential information disclosure and consent.<\/strong><\/li>\r\n      <\/ul>\r\n    <\/li>\r\n  <\/ol>\r\n<\/div>\r\n<\/div><\/div><div id=\"wpforms-447-field_455-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"455\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_455\">Signature <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-447-field_455\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][455]\" autocomplete=\"off\" required><div class=\"wpforms-signature-wrap wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-447-field_455-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Effacer la signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Effacer la signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-447-field_456-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"456\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"9\" data-formid=\"447\" disabled>Previous<\/button><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"9\" data-formid=\"447\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-10 last \" data-page=\"10\" style=\"display:none;\"><div id=\"wpforms-447-field_498-container\" class=\"wpforms-field wpforms-field-captcha\" data-field-id=\"498\"><label class=\"wpforms-field-label\" for=\"wpforms-447-field_498\">Custom Captcha <span class=\"wpforms-required-label\">*<\/span><\/label>\t\t\t<div class=\"wpforms-captcha-math\">\n\t\t\t\t<span id=\"wpforms-447-field_498-question\" class=\"wpforms-captcha-equation\">\n\t\t\t\t\t<span class=\"n1\">4<\/span>\n\t\t\t\t\t\t\t<span class=\"cal\">*<\/span>\n\t\t\t\t\t\t\t<span class=\"n2\">13<\/span>\t\t\t\t\t<span class=\"e\">=<\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"text\" id=\"wpforms-447-field_498\" class=\"wpforms-field-medium wpforms-field-required a\" data-rule-wpf-captcha=\"math\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][498][a]\" aria-describedby=\"wpforms-447-field_498-question\" required>\t\t\t\t<input type=\"hidden\" name=\"wpforms[fields][498][cal]\" class=\"cal\">\n\t\t\t\t<input type=\"hidden\" name=\"wpforms[fields][498][n2]\" class=\"n2\">\n\t\t\t\t<input type=\"hidden\" name=\"wpforms[fields][498][n1]\" class=\"n1\">\n\t\t\t<\/div>\n\t\t\t<\/div><div id=\"wpforms-447-field_296-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"296\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-447-field-hp\" class=\"wpforms-field-label\">Message<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-447-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"447\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/mediationcentreontario.com\/fr\/wp-json\/wp\/v2\/pages\/4796\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-447\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Formulaire d&rsquo;information sur la m\u00e9diation Veuillez prendre quelques instants pour remplir ce formulaire d&rsquo;information priv\u00e9 et confidentiel. Il s&rsquo;agit de la premi\u00e8re \u00e9tape de la proc\u00e9dure de m\u00e9diation confidentielle. La proc\u00e9dure ne peut commencer que lorsque nous avons re\u00e7u les formulaires d&rsquo;information des deux parties. Les services de m\u00e9ditation sont disponibles en personne et \u00e0 [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/mediationcentreontario.com\/fr\/wp-json\/wp\/v2\/pages\/4796"}],"collection":[{"href":"https:\/\/mediationcentreontario.com\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mediationcentreontario.com\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mediationcentreontario.com\/fr\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/mediationcentreontario.com\/fr\/wp-json\/wp\/v2\/comments?post=4796"}],"version-history":[{"count":13,"href":"https:\/\/mediationcentreontario.com\/fr\/wp-json\/wp\/v2\/pages\/4796\/revisions"}],"predecessor-version":[{"id":5389,"href":"https:\/\/mediationcentreontario.com\/fr\/wp-json\/wp\/v2\/pages\/4796\/revisions\/5389"}],"wp:attachment":[{"href":"https:\/\/mediationcentreontario.com\/fr\/wp-json\/wp\/v2\/media?parent=4796"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}