New Client Intake Form

Thank you so much for contacting our 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. Our 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 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.

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you.

Contact information

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

CLIENT INFORMATION

Contact information

Preferred Method of Communication:

PAYOR INFORMATION

Contact/Payor Name:

Phone:

E-mail:

Contact/Payor Relationship to Client:

ADDITIONAL QUESTIONS

Who will be responsible for paying bill?

Case Type:

Court:

Cause Number:

Charges:

Police Department/Agency Investigation case:

Police Report Number:

Juvenile Probation Counselor:

In Custody?

Which Jail/Prison?

How did you hear about us?

THANK YOU