Online referral form

Child 1
Please specify name, age & date of birth, whether male/female and whom living with
Child 2
Please specify name, age & date of birth, whether male/female and whom living with
Child 3
Please specify name, age & date of birth, whether male/female and whom living with
Child 4
Please specify name, age & date of birth, whether male/female and whom living with
Child 5
Please specify name, age & date of birth, whether male/female and whom living with
Child 6
Please specify name, age & date of birth, whether male/female and whom living with

Is this referral under Legal Services Funding?
- Yes
- No
Have any Court proceedings commenced?
- Yes
- No
If so, what proceedings, in which Court and what stage has been reached?
Date of Separation
Date of Decree Nisi
Date of Decree Absolute
Type of mediation sought

Please indicate whether in respect of Children, Property or Both
Has there been any history (alleged or actual) of violence, harassment, intimidation or child protection concerns?
- Yes
- No
Name of referrer
Position in firm
Your consent*
- I consent to Leonard Gray LLP storing my personal data

Need some initial advice?