Client Intake Form - Family Law New Client Form Title: * - Mr Mrs Miss Ms Dr Full Name: * Date of Birth: Place of Birth: Residential Address: * Postal Address: Work Phone: Home Phone: Mobile: * Fax: Email: * Occupation: Date commenced living together: Date of marriage (if applicable): Place of marriage (if applicable): Date of divorce (if applicable): What do you want to receive/achieve? How quickly do you expect us to undertake work for you?, eg. within hours or days of giving instructions? How much do you estimate you will need to pay in legal costs? Service, eg do you want a Rolls Royce service or do you want us to act on a consultancy basis, with you undertaking most of the work? Do you have a Will? Yes No Have you granted a Power of Attorney or Enduring Power of Attorney to anyone, including your Spouse/Partner? Yes No How did you hear about us? Please tick more than one if applicable: * I was referred by someone I visited your website I received your newsletter I read one of your articles I received one of your brochures in the mail I purchased your book I purchased your eBook I live locally and noticed your signage Other Spouse/Partner Full Name of Spouse/Partner: * Date of birth of Spouse/Partner: Place of birth of Spouse/Partner: Address of Spouse/Partner: Occupation of Spouse/Partner: Spouse/Partner Lawyer’s name (if known): Children (if any) Child 1 - Name: Date of Birth Child 1: Age of Child 1: Child 1 lives with: Child 2 - Name: Date of Birth Child 2: Age of Child 2: Child 2 lives with: Child 3 - Name: Date of Birth Child 3: Age of Child 3: Child 3 lives with: Child 4 - Name: Date of Birth Child 4: Age of Child 4: Child 4 lives with: Any further information/comments Thank you! Let us help you figure out your next move. Contact Us Now
