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Criminal Defense Intake Form

Contact Information: Name:* Email:* Phone Number:* Alternate Phone Number: Address: City: State: ZIP: Are you known by any other names? Yes No If yes, list other names you have used: What is your marital status? Does this matter involve a business you own or run? Yes No If yes, provide the business name, address, and phone: If a business is involved, how is the business organized (if known)? Are you employed? Yes No If yes, please provide your job title and employer's name and address: Can you be contacted at work? Yes No What area of law does your situation involve (if known)? Describe your situation, including any relevant dates: How would you rate your legal needs described here? Are any other people involved? Yes No If yes, provide names, addresses (if known), and their relationship to you, if any: Do you have any documents that could help explain your situation? Yes No If yes, list those documents and their dates: Are there other documents that you do not have access to that could be of assistance? Yes No If yes, list those documents and their dates and locations (if known): Describe how this situation has impacted you: Describe what you would like to happen to resolve your issue (your preferred outcome): Have other attorneys worked on this matter? Yes No If yes, provide names, addresses, and a brief description of their involvement: Yes No Special concerns: Where did you hear about this website?

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