Free Family Law Intake Form template
A careful intake for sensitive matters: situation, children, urgency, and safety.
8 questions · 1 page · about 5 minutes to answer · fully editable after you start
Family matters arrive raw, and the intake must be gentle without losing the facts that determine urgency. This form collects the essentials with care: the situation and what prompted contact now, children and current arrangements, urgency including the safety question asked plainly and privately, and what the client hopes the process achieves.
The safety question opens an urgent-contact path: a Yes shows the emergency number again and asks when and how it is safe to reach the client, so nobody waits on the form for help. The survey does not alert anyone by itself: before you share it, add a rule on Act's Automations page that emails your team when the safety answer is Yes, which is the whole point of asking early.
Replace [local emergency number, e.g. 000] and [local crisis line, e.g. Lifeline on 13 11 14] in its opening note with the services where your respondents live, before you share it: the numbers shown are Australia's. The Collect tab lists both until they are changed.
Template preview
This is a picture of every question as a respondent would see it, so nothing on it can be clicked or typed into. Use this template to get your own editable copy.
Opens in the Light theme, or in your own default theme if you have set one — change it anytime to any of the 4 built-in looks, or build your own on a paid plan.
Page 1
Your situation
This form tells us about you and your situation, and how to reach you safely. Complete it only on a device and in a place where you feel safe. It takes about 5 minutes.
This form is not an emergency service. If you or your children are in immediate danger, call [local emergency number, e.g. 000]. For crisis support, call [local crisis line, e.g. Lifeline on 13 11 14].
Q1.Your name, and a safe way to reach you*
Q2.Which is safe for us to use? We will use only this one.*
- Phone call
- Text message
Q3.What does your matter concern?*
- Divorce or separation
- Child arrangements
- Financial settlement
- Cohabitation/property dispute
- Pre/post-nuptial agreement
- Other…
Q4.Briefly, what is happening and what prompted you to reach out now?*
Q5.Children involved? Ages and current arrangements (write None if none)*
Q6.Do you have any concerns for your or your children's safety?*
- No
- Yes - please contact me urgently
- Prefer to discuss in person
Thank you for telling us. If you or your children are in immediate danger now, call [local emergency number, e.g. 000]. Otherwise we will contact you as soon as we can, only in the way you chose above.
Shown only if the answer to Q6 is “Yes - please contact me urgently”.
Q7.When is it safe for us to contact you, and is there anything we should avoid (for example, leaving a voicemail)?
Asked only if the answer to Q6 is “Yes - please contact me urgently”.
Q8.What would a good outcome look like for you?
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