CLIENT INTAKE FORM
1. Name
2. Addresses
Home:
Business:
4. Which address should attorney's billings be sent to?
5. Telephone numbers
Home:
Work: What days and times should work number be used?
Fax number
Which telephone number should be used for messages?
6. Employer
7. Occupation
8. Date and place of birth
9. Driver's license number
10. Social security number
11. United States citizen? Immigration status:
12. Spouse's information
Name
Date and place of birth
Date of marriage
Address, if different
Work address
Home telephone number, if different
Work telephone number What days and hours should work number be used?
13. Insurance information
Name of insurance agent
Home insurance coverage
Vehicle insurance coverage
Medical insurance coverage
Other
14. What are the names of any other lawyers you have ever consulted regarding this case?
15. Describe any papers you been served with concerning this case
16. Describe any documents you have relating to this case.
17. Do you have access to your files or papers relating to this case?
18. Identify any witnesses or people with knowledge of the facts of this case.
19. Describe any statements you have made to anyone concerning this case?
20. How did you choose our firm?
Warning:
These forms are provided AS IS. They may not be any good. Even if they are good in one jurisdiction, they may not work in another. And the facts of your situation may make these forms inappropriate for you. They are for informational purposes only, and you should consult an attorney before using them.
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