Intake Form Please enable JavaScript in your browser to complete this form.Date of Initial Phone/Walk-in *By: *New/Former Client? *New ClientFormer ClientClient IDMatter ID Fee Agreement Signed:YesNoPayment received:YesNoType of Fee Arrangement:HourlyFlatContingentMixedConflicts Checked forConflicts Checked byFirstLastImportant Dates to Calendar:FirstLastFile Set Up?YesNoClient Contact:Client Name: *FirstLastReferred by:Client Address:City, State, Zip:Main Phone: *Work Phone:Cell Phone:Email Address: *Matter Type: *Brief Description of Matter:Billing Contact (if different from above):Client Name:FirstLastClient Address:Phone:Email Address:The information provided during the consultation is purely for informational purposes and should not be relied upon as legal advice. The consultation does not in itself create an attorney-client relationship; a separate written agreement is needed. The information and input you provide will remain confidential and will not be provided to any other third parties. I agree to the terms and conditions above. *SignatureName *NameDate *DateSubmit
