Thank you so much for contacting our law office! This form is used to collect information for internal purposes only. The information you provide will remain confidential. Please answer all questions fully and accurately to the best of your knowledge.

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 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 our law office. We look forward to working with you!

Contact information

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First name *

Middle name

Last name *

Date of birth

Company

Emails

Email Address *

Type

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Addresses

Street address

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State/Region

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Phone numbers

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Case and Matter Information

THANK YOU

Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We 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

Preferred Contact Method

Gender

Social Security Number

Driver's License Number

Please list all Aliases:

Marital Status

Are you currently employed?

How were you referred to our law firm?

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

If this representation is regarding an entity please list all partners (Full First Name and Last Name) and title for the entity.

Name of Entity (LLC or Corporation) to Represent:

Please upload documents regarding your entity/matter

Case and Matter Information

Type of Matter

Brief description of matter/case.

Date of Incident:

Date Problem Began:

County where events occurred:

Please provide an estimated financial losses

Physical Injuries (if any)

Emotional Distress?

Have you received any medical or psychological treatment?

Have you spoken with another attorney?

Describe or list any relevant documents to the matter/case.

Do you currently have any relevant or important documents?

Is there a Court Case Number?

If applicable, please provide information of any other affected parties on either side of the issue (list party, relationship, and how they are affected):

ACKNOWLEDGEMENT AND ACCEPTANCE

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