Client questionnaire

Please fill out this questionnaire and return it as soon as possible. It is important that you answer each question fully.

You should answer all questions. If a question does not apply to your particular situation, please indicate by marking the question "N/A".

Your responses to these questions will help to organize your case and will save you money on attorney's fees in trying to gather and assemble information after the case is in progress.

Since your answers are being made to an attorney, you are assured of confidentiality and are protected by the attorney-client privilege.

CLIENT'S PERSONAL INFORMATION

Contact information

Prefix

First name *

Middle name

Last name *

Date of birth

Company

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

Current Address and contact information

(If you wish to have your mail sent to a different address, please advise the attorney during your consultation)

ADDITIONAL INFORMATION

CLIENT'S EMPLOYMENT

OPPOSING PARTY

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.

Your Full Name

CLIENT'S PERSONAL INFORMATION

Contact information

Birth date

City & State of birth

Social Security No.

Driver's License No.

Education

Spouse’s name

Current Address and contact information

Address

Mobile phone

Home phone

Fax

Email Address

ADDITIONAL INFORMATION

How were you referred to this office?

Have you consulted or retained any other attorneys on this matter before coming to this office?

Existing cases relevant to this issue?

CLIENT'S EMPLOYMENT

Employer

Job tittle

Address

Phone Number

May we call you at work?

OPPOSING PARTY

Opposing party name

Opposing party address

Name of associated and/or related parties

Name of current opposing counsel and address

MATTER INFORMATION

Have you or any member of your family been seen by anyone in this office?

Please briefly summarize your matter

If this case involves custody/visitation of minor(s), please list minor’s name and date of birth

Best time to reach you or schedule and appointment

THANK YOU

E-ACKNOWLEDGEMENT AND ACCEPTANCE