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Solicitor Referral Form
Please fill out this form below.
Client Details:
Client A
Name
Date of Birth
Address Line 1
Address Line 2
Town/City
County
Postcode
Mobile Number
Home Number
Email
Solicitor
Name
Address
Phone Number
Have the other party’s solicitors agreed to the referral?
Please select
Yes
No
Not Known
Is the other party aware of the referral?
Please select
Yes
No
Any other professionals involved?
Please select
Court
Cafcass
Social Services
Other
Any special needs? Please specify
Client B
Name
Date of Birth
Address Line 1
Address Line 2
Town/City
County
Postcode
Mobile Number
Home Number
Email
Solicitor
Name
Address
Phone Number
Any special needs? Please specify
Dates:
Date of marriage/cohabitation
Date of separation
History:
Is there any history of, or allegations of, Domestic Violence or Child Abuse? Or have there been any Injunction Proceedings?
Please select
Yes
No
If yes, please give brief details:
Children:
Child
Name
Age/Date of Birth
Resident with?
New Partner?
Client A
Client B
Mediation required:
Issues for Mediation
Please select
Child Only Mediation
Finances (inc Property) Mediation
All Issues (Child, Finances, Property)
Brief outline of the situation:
Please give brief details
Submit
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