NEW CLIENT INTAKE FORM - Parslow Tyas
New Client Intake Form
Reason for Consultation (i.e. divorce, separation, marriage contract, general consultation, second opinion): _____________________________________
Referral Source: _______________________________
Client Information
Full Legal Name: __________________________________
Date of Birth: _____________________ Place of Birth: ________________________
Citizenship: _______________________ SIN number: __________________________
Surname at Birth: _________________ Surname Before Marriage: _____________
Current Home Address: _______________________________________________________
Since When? _____________________
Current Mailing Address (if different from home address): ______________________________________________________________________________
Home Tel.: ___________________ Work Tel.: _____________________________
Cell: _________________________ Fax: __________________________________
E-mail: ______________________________________________________________________
Preferred Method of Communication: __________________________________________
Divorced Before? _____________________ Place and Date: _______________________
Job Title: ____________________________________________________________________
Current employer and address: ________________________________________________ ______________________________________________________________________________
Current annual income from employment: $_______________________
Income from other sources: $_____________________ (break down other sources)
Current or Previous Family Lawyer: ____________________________________________
Spouse Information
Full Legal Name: ________________________________
Date of Birth: _____________________ Place of Birth: ________________________
Citizenship: _______________________ SIN number: __________________________
Surname at Birth: _________________ Surname Before Marriage: _____________
Current Home Address: _______________________________________________________
Since When? _____________________
Current Mailing Address (if different from home address): ______________________________________________________________________________
Home Tel: ____________________ Work Tel: _____________________________
Cell: _________________________ Fax: __________________________________
E-mail: ______________________________________________________________________
Divorced Before? _____________________ Place and Date: _______________________
Job Title: ____________________________________________________________________
Current employer and address: ________________________________________________ ______________________________________________________________________________
Current annual income from employment: $_______________________
Income from other sources: $_____________________ (break down other sources)
Spouse’s lawyer and contact information: _____________________________________
______________________________________________________________________________
Marital Information
Date of Marriage: ________________________
Date of Cohabitation: ______________________
Place of Marriage: ____________________
Date of Separation: _______________________
Have either you, your spouse, or children been in a court case before? Yes No
Have you and your spouse made a written agreement dealing with any matter involved in this case? Yes No
If client or spouse is stay-at-home parent, please give relevant dates:
_____________________________________________________________________________
Do you have any safety concerns for yourself or your children? Yes No
Have the police been called to the matrimonial home and does either spouse have a criminal record? Yes No
Matrimonial Home
First:
Address: _________________________________________________________________
Name(s) on Title: _________________________________
Value: $______________________ Mortgage: $________________________
Second:
Address: _________________________________________________________________
Name(s) on Title: _________________________________
Value: $______________________ Mortgage: $________________________
Excluded Property
Received by client (during or after marriage):
______________________________________________________________________________
Received by client’s spouse (during or after marriage):
______________________________________________________________________________
Children
|Name |Date of Birth |Living With |Grade/School |
| | | | |
| | | | |
| | | | |
| | | | |
Children’s Expenses
Medical/Dental/Orthodontic: __________________________________________________
______________________________________________________________________________
Private School/Tutoring/Educational Expenses: _________________________________
______________________________________________________________________________
Post-secondary Educational Expenses: _________________________________________
______________________________________________________________________________
Daycare/Child Care: __________________________________________________________
______________________________________________________________________________
Extracurricular Activities: _____________________________________________________
_____________________________________________________________________________
Other Expenses: _____________________________________________________________ ______________________________________________________________________________
Next Steps:
Open DIVORCEmate file
Order title search of matrimonial homes (see page 3)
Register Matrimonial Home designation on homes owned by client’s spouse
Refer client to estates lawyer for new will: _______________________________
Letter to client’s spouse or client’s spouses’ lawyer
Follow up with client re drafting financial statement and disclosure
Contact Accountant – Name of accountant: ______________________________
Collect information for Form 35.1 Financial Statement
Follow-up letter or email to client outlining opinion and next steps
1. _____________________________________________
2. _____________________________________________
3. _____________________________________________
4. _____________________________________________
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