TRACY DUELL-CAZES

TRACY DUELL-CAZES
724 SOUTH CENTRAL AVE., STE. 213F MEDFORD, OR 97501

E-MAIL: TRACY@TDCFAMILYLAW.COM
TELEPHONE: (541) 665-8485
POTENTIAL CLIENT CONSULTATION FORM
TODAY’S DATE

MonthDayYear
Date
PERSONAL INFORMATION:
YOUR NAME
HOMEADDRESS (INCLUDINGCITY, STATE& ZIP)
HOMEADDRESS (INCLUDINGCITY, STATE& ZIP)
EMPLOYER’S NAME& ADDRESS, CITY, STATE& ZIP
EMPLOYER’S NAME& ADDRESS, CITY, STATE& ZIP
DATEOFHIRE

MonthDayYear
Date
YOUR JOB TITLE
CAN YOU BE CONTACTED YES/NO
Format: (000) 000-0000.
CAN YOU BE CONTACTED YES/NO
Format: (000) 000-0000.
E-MAIL
example@example.com
CELL PHONE
Format: (000) 000-0000.
HOW WERE YOU REFERRED TO THIS OFFICE?
OFFICE WEBSITE
OTHER
CASE INFORMATION:
NAME OF OPPOSING PARTY (OTHER PARENT)
CASE NO.
TIME
COURT LOCATION/DEPARTMENT
BRIEF DESCRIPTION OF SERVICES ABOUT WHICH YOU ARE CONSULTING THIS OFFICE:
FOR OFFICE USE ONLY
FILE NO.
AMOUNT
BILLING NO.
RETAINER
PAID
MARRIAGE/PARTNERSHIP INFORMATION FOR CURRENT MATTER : [if applicable]
DATE MARRIED/REGISTERED

MonthDayYear
Date
WHERE
DATE SEPARATED

MonthDayYear
Date
LENGTH OF MARRIAGE/PARTNERSHIP:
YRS.
YRS.
DATE DIVORCED/TERMINATED

MonthDayYear
Date
WHERE
YOUR FORMER NAME
IS THERE A PRE-MARITAL OR POST-MARITAL AGREEMENT: YES/NO
OPPOSING PARTY/PARENT INFORMATION:
DOES PERSON HAVE AN ATTORNEY? YES/NO. IF YES, WHO
OTHER PARTY’S FULL NAME
ADDRESS (including city and zip code)
ADDRESS (including city and zip code)
EMPLOYER'S NAME AND ADDRESS (including city and zip code) and JOB TITLE
EMPLOYER'S NAME AND ADDRESS (including city and zip code) and JOB TITLE
HOME PHONE
WORK PHONE
Format: (000) 000-0000.
WORK PHONE
CELL PHONE
Format: (000) 000-0000.
CELL PHONE
CELL PHONE
Format: (000) 000-0000.
MALE/FEMALE RACE
HEIGHT ' " WEIGHT
HAIR COLOR
EYE COLOR
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):
CHILD'S NAME
GENDER
WHO DO THE CHILDREN RESIDE WITH?: YOU/OPPOSING PARTY/OTHER
CHILDREN HAVE RESIDED CONTINUOUSLY IN CALIFORNIA LAST FIVE (5) YEARS?: YES/NO
IF NOT, WHERE ELSE?
ANY OTHER MINOR CHILDREN: YOU(#)
OPPOSING PARTY(#)
PERSONAL INFORMATION:
YOU
YOU
OTHER PERSON
OTHER PERSON
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.
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.
POTENTIAL CLIENT SIGNATURE
Should be Empty:

TRACY DUELL-CAZES

TELEPHONE: (541) 665-8485

PERSONAL INFORMATION:

CASE INFORMATION:

FOR OFFICE USE ONLY

OPPOSING PARTY/PARENT INFORMATION:

PERSONAL INFORMATION: