Name of Solicitors Firm or Body:

Referring Solicitor or Legal Professional:

Address:

Postcode:

Telephone:

Name of Client:

Name of Case:

Case Summary:

Civil case or Legal Aid:

Type of Expert required or name if known:

Specify Psychologist or Psychiatrist:

Summary of Instructions:

State whether Single or Joint Instruction:

<-- Please select --> Statements Cafcass reports GP or Hospital records Social Worker Reports Video Tapes Other Materials Photographic Evidence Other (please specify)

Specify Reading/Visual Material (by the hour):

Report to be filed by:

Name of Court:

Court Dates:

Direction Hearing:

Final Hearing:

Will the Expert be required to attend court?