Polk County Courthouse, Benton
If you are seeking custody of your child, the judge
will want to know how well you and the other parent can face situations as they
arise, including medical concerns, educational matters, and other issues.
The questions below address those concerns. (This
Child
Custody Questionnaire
is
also
available for downloading
if you click on the underlined words.
If you do not have a copy of
Adobe Acrobat Reader to read it, please click below.)

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Do your children currently reside with you? |
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How long have they lived with you? |
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Did you take care of the children alone at home? |
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What was the normal weekly routine? |
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Do the children attend school or day care? |
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How often do you take them? |
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How often do you pick them up? |
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Name their teachers or day care providers. |
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How often do you take the children to the doctor? |
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Name their doctors since birth. |
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What medical ailments have the children had? |
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How often were you responsible for giving the children medicine? |
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What medicines work best? |
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Any medicine they prefer? |
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Any medicine they dislike? |
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How often were you responsible for changing their diapers? |
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How often were you responsible for feeding the children? |
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What are their favorite foods or meals? |
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What are their least favorite foods or meals? |
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Any foods that cause them problems?
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How often were you responsible for waking them? |
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How often were you responsible for getting them to bed? |
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How often were you responsible for bathing them? |
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How often were you responsible for getting them dressed? |
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How often did you pick out their clothes? |
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What are their favorites clothing items, outfits and/or colors? |
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How often were you responsible for grooming the children? |
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How often were you responsible for picking out their furniture? |
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How often were you responsible for arranging a baby sitter? |
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How often were you responsible for taking the children for recreation? |
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Where do the children like to go or do for fun? |
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How often did you arrange playmates for your children? |
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Who are their preferred friends? |
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How often were you the one who chose the toys for the children? |
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What are their favorite toys? |
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What are their least favorite toys? |
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How often were you the one who arranged birthday parties for the
children? |
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How often were you the one took the children to church?
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How do you stop your children from misbehaving? |
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How do you compliment your children? |
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How often do you tell your children you love them? |
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Describe your children. |