General Intake Form

*Name:

*Address:

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*Home Phone:

Date Of Accident:

Location Of Accident (Address, City, State):

Business Phone:

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Are you known by any other names?
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If yes, list other names you have used:

What is your marital status?
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Does this matter involve a business you own or run?
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If yes, provide the business name, address, and phone:

If a business is involved, how is the business organized (if known)?
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Are you employed?
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If yes, please provide your job title and employer's name and address.

Can you be contacted at work?
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What area of law does your situation involve (if known)?
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Describe your situation, including any relevant dates:

How would you rate your legal needs described here?
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Are any other people involved?
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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?
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If yes, list those documents and their dates:

Are there other documents that you do not have access to that could be of assistance?
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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?
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If yes, provide names, addresses, and a brief description of their involvement:

Special concerns:

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