TRACY DUELL-CAZES - Potential New Client Form

POTENTIAL CLIENT CONSULTATION FORM
TODAY’S DATE

MonthDayYear
Date
PERSONAL INFORMATION:
YOUR NAME
HOME ADDRESS (INCLUDING CITY, STATE & ZIP)
EMPLOYER’S NAME & ADDRESS, CITY, STATE & ZIP
DATE OF HIRE

MonthDayYear
Date
YOUR JOB TITLE
HOME PHONE NUMBER
Format: (000) 000-0000.
CAN YOU BE CONTACTED AT THIS NUMBER?
WORK PHONE NUMBER
Format: (000) 000-0000.
CAN YOU BE CONTACTED AT THIS NUMBER?
E-MAIL
example@example.com
CAN YOU BE CONTACTED AT THIS EMAIL ADDRESS?
CELL PHONE
Format: (000) 000-0000.
CAN YOU BE CONTACTED AT THIS NUMBER?
HOW WERE YOU REFERRED TO THIS OFFICE?
DID YOU FIND US THROUGH OUR WEBSITE?
PLEASE SPECIFY

CASE INFORMATION:
NAME OF OPPOSING PARTY (OTHER PARENT)
CASE NO.
NEXT COURT DATE

MonthDayYear
Date
TIME
COURT LOCATION/DEPARTMENT
BRIEF DESCRIPTION OF SERVICES ABOUT WHICH YOU ARE CONSULTING THIS OFFICE:

MARRIAGE/PARTNERSHIP INFORMATION FOR CURRENT MATTER : [if applicable]
DATE MARRIED/REGISTERED

MonthDayYear
Date
WHERE
DATE SEPARATED

MonthDayYear
Date
LENGTH OF MARRIAGE/PARTNERSHIP:
YEARS
MONTHS
DATE DIVORCED/TERMINATED

MonthDayYear
Date
WHERE
YOUR FORMER NAME
TO BE RESTORED: YES/NO
IS THERE A PRE-MARITAL OR POST-MARITAL AGREEMENT: YES/NO

OPPOSING PARTY/PARENT INFORMATION:
DOES PERSON HAVE AN ATTORNEY?
IF YES, WHO?
OTHER PARTY’S FULL NAME
ADDRESS (including city and zip code)
EMPLOYER'S NAME AND ADDRESS (including city and zip code) and JOB TITLE
HOME PHONE
Format: (000) 000-0000.
WORK PHONE
Format: (000) 000-0000.
CELL PHONE
Format: (000) 000-0000.
GENDER
RACE
HEIGHT
WEIGHT
HAIR COLOR
EYE COLOR

OPPOSING PARTY/PARENT INFORMATION: (CONTINUED)
ANY ALIASES (for example, maiden name, previous name, AKA, "street" name, etc.)
RESIDING WITH ANOTHER PERSON: YES/NO NAME
NATURE OF ABOVE RELATIONSHIP: MARRIED/SIGNIFICANT OTHER/ROOMMATE/OTHER

CHILDREN OF THIS RELATIONSHIP (if any):

Rows	CHILD'S NAME	BIRTHDATE	GENDER	AGE

WHO DO THE CHILDREN RESIDE WITH?: YOU/OPPOSING PARTY/OTHER
Have the Children resided continuously in California for the last 5 years? (Yes/No)
IF NOT, WHERE ELSE?
ANY OTHER MINOR CHILDREN: YOU(#)
OPPOSING PARTY(#)

PERSONAL INFORMATION:
YOUR BIRTHDAY

MonthDayYear
Date
YOUR CITIZENSHIP
OTHER PERSON'S BIRTHDAY

MonthDayYear
Date
OTHER PERSON'S CITIZENSHIP
YOUR GROSS MONTHLY INCOME
OTHER PERSON'S GROSS MONTHLY INCOME
I UNDERSTAND THAT TRACY DUELL-CAZES WILL NOT TAKE ANY ACTION ON MY BEHALF BEYOND THIS CONSULTATION UNLESS WE BOTH SIGN A RETAINER AGREEMENT AND I PAY THE AGREED RETAINER.
First and Last Name

First NameLast Name
I agree that my electronic signature above is the legal equivalent of my manual/handwritten signature on this document. By selecting “I AGREE” using any device, means, or action, I agree that my signature on this document is as valid as if I signed the document in writing.
CLICK "I AGREE"
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