Marital Status Questionnaire

marital status questionnaire is designed to address issues that are specifically concerned with the relationship status of an individual. The respondents are required to provide information concerning their marital status in relation to a particular purpose such as employment or filing of taxes.

The marital status is the specified variable of a marital status questionnaire owing to is impact on a particular situation that the questionnaire aims at addressing. These kinds of questionnaires are useful for people who are recently separated and wish to handle issues that may have legal repercussions. The following is a sample of a marital status questionnaire.

Sample Marital Status Questionnaire

Name __________________________

Age __________________________

Gender __________________________

Address __________________________

Telephone Number __________________________

Fax Number __________________________

Email Address __________________________

Marital Status __________________________

Separation Date__________________________ (Provide month, date and year)

Separation Status (Tick against one of the following)

Temporary __________________________

Pending Divorce __________________________

Unknown Status __________________________

Do you still have a joint account with your estranged spouse?

  1. Yes
  2. No

If no, please state when the account was closed __________________________

Did you file taxes jointly with your estranged spouse?


If yes, please specify when you last did so __________________________How do you plant to file your taxes in future?

  1. Single
  2. Divorced
  3. Not sure

Are you currently involved in any legal custody issues involving your children?


Are any child visitation rights currently in place?


If yes, please outline the arrangements that have been made __________________________

Do you and your estranged spouse live together at this time?

  1. Yes
  2. No

Do you have any legal separation documentation in your possession?


Are your family members aware that you are separated from your spouse?


Do you and your estranged spouse share any utility bills?


Category: Medical Questionnaire

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