Client Intake Form
This gives us important background information prior to your consultation. Please leave blank any questions you are unable to answer. Note that the client is the individual for whom the report is being prepared.
First name of the Client
Middle name of the Client
Last name of the Client
Preferred title of the Client
Mr
Miss
Ms
Mrs
Other
Date of Birth of the Client
-
Day
-
Month
Year
Date
Gender of the Client
Male
Female
Indeterminate/Intersex/Prefer not to say
Residential Address of the Client
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email of the Client
Optional.
Phone Number for the Client
Best time to reach the Client by phone
Is the Client Represented by a legal practitioner or other similarly qualified professional?
Yes, the client is Represented
No, the client is not Represented
Client's alternative contact (or representative) name
Client's alternative contact (or representative) email
example@example.com
Client's alternative contact (or representative) phone number
Best time to reach alternative contact (or representative)
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Background
Please please provide a short background of the purpose of the report:
If this form is being completed by a legal practitioner, you may with to include relevant provisions
Are there any specific time limitations associated with this matter
-
Day
-
Month
Year
Leave blank if not relevant, or there is no limitation.
Please detail what then nature of the limitation date:
Please provide detail on the Client's Immediate Family:
If the client is a child, this includes parents and siblings. If the child is an adult, this includes spouse or de facto partner, children and other dependants living in the same home.
Please detail on the procedural history for the client.
Reports that evidence a strong understanding of the underlying matter and any previous decisions, tend to be considered by decision-makers as more probative
We recommend providing any background inf
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