Attorney-Client Privileged Information

Attorney-Client Privileged Information CONFIDENTIAL PROSPECTIVE CLIENT QUESTIONNAIRE

Your Personal Information: Date:______

Name:______(First) (Middle) (Last) (Maiden)

Home Address:______(Street/P.O. Box) (City)

(Coun ty) (State )

May we send your mail to your home address? Yes No If not, provide an alternate mailing address:______

Telephone: Home ______May we call you there? Yes No Work ______May we call you there? Yes No Cell ______May we call you there? Yes No Other numbers where you can be reached: ______

E-mail address: ______May we contact you there? Yes No Birth:______(Date: DD/MM/YY) (Place)

(Present Age)

Name of your employer: ______

Occupation: ______Hours worked:______

Length of employment: ______

How long have you lived: In Texas? ______In your county? ______

Confidential Prospective Client Questionnaire – Page 1 (Rev. 07/06) © Collaborative Law Institute of Texas, Inc. 2003 Personal Information of Your Spouse, Ex-Spouse or Other Party:

Name:______(First) (Middle) (Last) (Maiden)

Home Address:______(Street/P.O. Box) (City)

(County) (State) (Zip)

Telephone: Home ______; Work ______; Cell ______

Birth:______(Date: DD/MM/YY) (Place) (Present Age)

Name of other party’s employer: ______Length of employment: ______

Occupation: ______Hours worked:______Marriage (If divorce being considered):

Date and Place of Marriage:______(DD/MM/YY) (City, State) Date of Separation: ______(DD/MM/YY) Have you ever signed a pre-marital or post-marital agreement? ______Pre-Marital/Post-Marital Agreement Matters:

Date and Place of (Contemplated) Marriage: ______(DD/MM/YY) (City, State) ______Post-Decree Matters:

Date and Place of Decree:______(DD/MM/YY) (City, County, State) Cause Number of Case and Court (if known): ______Children (whether minors or not) Name (first,middle,last) Age Date of Birth Grade School (DD/MM/YY) Attending

Confidential Prospective Client Questionnaire – Page 2 (Rev. 07/06) © Collaborative Law Institute of Texas, Inc. 2003 ______

How did you hear about our firm? ______

Former Client ______Lawyer Referral ______Name Name Other ______

List any attorney consulted by you previously in this matter: ______

List any attorney consulted by the other party in this matter: ______