Action For Fathers New Nov

"Case Overview Form"

Designed to give you the best out of your consultation!

PRIVATE & CONFIDENTIAL
Please fill in all fields to help us speed your Enquiry!

Please be honest and tell us all the correct facts about your case. Please note that some questions may seem personal, the questions are made to you without judgement. Your disclosure is confidential and will not be shared with anyone else.
DATA PROTECTION & CONFIDENTUALITY GDPR. We will never share your information with a third party. We will however store your data and contact you at times*
I have read the terms and conditions of Action For Fathers.*
I understand that Action For Fathers is not a charity*
I am aware that Action For Fathers are not solicitors or regulated by the law society*
Calls are recorded for training and security purposes*
What service are you requiring*
If you are applying for 'Fixed fee to Court' - One of our advisor's will contact you to arrange the next stage.
How are you funding your case*
Please be sure to fill in all fields and give as much information that you can. Sometimes even the smallest of detail can have a big impact on your case.

It is imperitive, you must be honest with regards to all information given, failure to do this may result in your application faultering if the information that you give is incorrect or untrue.

All information disclosed is confidential and is not shared with any third party.
How did you find out about us?*
Name*

First NameLast Name
Any previous names*
DOB*

DayMonthYear
Country/place of birth*
Phone Number*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Have you lived at this address for more than five years?*
Previous address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Description*
Your Annual salary/ to calculate CSA/ recieve court fee exemption*
Have you ever suffered or been diagnosed with any mental health issues?*
Are you on medication now?
What medication do you take and what dosage?
Second Parents Name*

First NameLast Name
Any previous names
Second parents DOB*

MonthDayYear
Second parents place of birth
Job Description*
Phone Number- if known..we will not contact without your consent

Area CodePhone Number
E-mail- if known..we will not contact without your consent
Do you know their address?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you know their relations address?*
Have they lived at this address for more than five years?*
Has your partner suffered from or been diagnosed with mental health issues?*
Do you know what medication they are on and the dosage?
Previous address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have children with your ex partner?*
How many children do you have?

1234Other
Name*

First NameLast Name
Name*

First NameLast Name
Name*

First NameLast Name
DOB*

MonthDayYear
Name*

First NameLast Name
DOB*

MonthDayYear
Name*

First NameLast Name
DOB*

MonthDayYear
Name*

First NameLast Name
DOB*

MonthDayYear
Name*

First NameLast Name
DOB*

MonthDayYear
Describe the maternal mother of your children as a person*
Please enter additional children names and date of births
Are you named on the birth certificate*
Phone Number

Area CodePhone Number
Were you married?*
How long were you married
How long have you been separated?*
Have you and your ex-partner attended Mediation in the last 4 months?*
Who do the children live with?*

FatherMotherOther
If other, please specify
Do you currently pay maintenance?*
How was this agreed?
Do you have other children from a previous or new relationship*
If yes, how many children do you have?

1234Other
Name

First NameLast Name
DOB

MonthDayYear
Date
Name

First NameLast Name
DOB

MonthDayYear
Date
Name

First NameLast Name
DOB

MonthDayYear
Date
Name

First NameLast Name
DOB

MonthDayYear
Date
Do you have a good relationship with the mother
Would she provide a positive character reference as a father
Do you have a new partner*
How long have you been together?
Name

First NameLast Name
Does your new partner have children
If yes please state how many and fill in their details

1234Other
Name

First NameLast Name
Date

MonthDayYear
Date
Name

First NameLast Name
Date

MonthDayYear
Date
Name

First NameLast Name
Date

MonthDayYear
Date
Name

First NameLast Name
Date

MonthDayYear
Date
Occupation
Do they offer family support?
How much do you pay in Maintenance?*
Have you ever attended mediation?*
How long ago did you attend?
Have you ever offered mediation to your spouse?*
What is their name

First NameLast Name
If yes please specify name
Does your ex partner have a new partner*
Does your ex partners partner have children
If yes, how many children do they have?

1234Other
Name

First NameLast Name
Approximate age
Name

First NameLast Name
Approximate age
Name

First NameLast Name
Approximate age
Name

First NameLast Name
Approximate age
Did your relationship incur any police involvement?*
Please give a description
Were there any accusations of domestic violence?*
Confirm who was the alleged victim of domestic violence
Confirm was there a conviction made
Please give a description
Who was convicted
Please give a description
Do you have a criminal record?*
Please give a description
Any previous court orders?*
Please give a description
Are social services involved?*
Please give a description
DO YOU HAVE ACCESS NOW?*
Have you previously had independent contact*
Please give a description of your child arrangement agreement.
Please give details of any informal contact agreed*
Please give a description of how long ago access has been withdrawn and why it was stopped.*
Do you have accommodation to facilitate your child/children?*

YesNo
Please give details of your accommodation.
Do you have family support?*

YesNo
Have you had any previous legal representation?*
Do you have supporting evidence?

YesNo
Does your legal representative hold your files?*
Are your accounts all settled with your previous legal team?*
Do you have any previous paperwork?*
Please upload any relevant files/not full bundles

Browse Files

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Please tell us what your end goal is.*
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Please fill in all fields to help us speed your Enquiry!