General Intake Form

Thank you so much for contacting my law office! Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.

Privacy Policy

All information received from a client is strictly confidential. The firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

Your Social Security Number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

Social Security Numbers are most often used to positively identify parties. Most courts require Social Security Numbers of all parties in a case. Some other examples of how this information may be used include:

initial service
in court orders
in required reports or other documents filed with the State

If you have any questions, please don't hesitate to contact the office. I look forward to working with you!

Contact information: Client

Prefix

First name *

Middle name

Last name *

Date of birth

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Spouse

Please fill out this section if you are married. Please note, even if your spouse is not involved in the current legal matter, this information is necessary for the firm to conduct the required conflict of interest check. Thank you.

Children

Please fill out this section if you have children. Please note, even if your child(ren) is (are) not involved in the current legal matter, this information is necessary for the firm to conduct the required conflict of interest check. Thank you.

Other Related Parties

Please be sure to list the names of ALL involved parties (friends, relative(s) not listed above, significant other, beneficiaries, etc.) that you are aware of. The names are necessary for the firm to conduct the required conflict of interest check.

Legal Services

THANK YOU

Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. I will contact you as soon as possible with any updates.

Please click the SUBMIT button below when you have finished answering all questions.

Contact information: Client

Which county do you live in?

Mailing address (if different from street address)

Preferred name

Preferred contact method

Are you currently employed?

Marital status

Spouse

Spouse's name

Spouse's street address

Spouse's mailing address (if different from street address)

Spouse's date of birth

Spouse's phone number

Spouse's email

Is your spouse currently employed?

Children

Do you have children?

Other Related Parties

Are there any other parties involved? (Such as a significant other, parent(s), other relatives, friends, beneficiaries, etc.)

Legal Services

What types of legal services are you looking for assistance with?

If you selected Other, what type of legal services are you looking for?

If married, will you be seeking legal services (such as wills, a joint trust, or advance directives) for both spouses?

If this law firm ends up representing you in this matter, will you be the person who pays the legal fees?

How were you referred to this law firm?

ACKNOWLEDGEMENT AND ACCEPTANCE

THANK YOU