Client Intake Form: Criminal Case

First Name *

Middle

Last Name *

Gender *
MaleFemale

Address *

City *

State *

Zip Code *

How long have you lived there? *

Home Phone

Cell Phone *

Work Phone

Can we call you at work? *
YesNo

E-Mail Address *

City of Birth

Date of Birth: *

Social Security Number (Last 4 Digits)

Driver’s License Number*

Is it a valid Driver’s License? *
YesNo

Are you a United States citizen? *
YesNo

Height

Weight

Hair

Eye

Marital Status

Do you have any Dependants?

Are you a currently employed? *

Employer Name

How long have you worked there?

Employer’s Address:

Questionnaire

Have you ever missed a court appearance anywhere before?
YesNo

Do you have any unpaid fines or court costs anywhere?
YesNo

Are there any other charges pending against you beside these?
YesNo

Are you currently on parole or probation anywhere?
YesNo

Is there any suspended jail time hanging over your head?
YesNo

Are there any warrants out for you’re your arrest anywhere?
YesNo

Were you jailed on the current charges?
YesNo

Did you have to post any money as bond in this case?
YesNo

Have you EVER pled to, or been convicted of, ANY criminal charges, including juvenile charges, out-of-state charges, or traffic offenses other than minor traffic tickets?
YesNo

It is vitally important and in your best interest that we are aware of ALL past charges so we can adequately assess your situation and properly advise you. Failure to list all prior offenses can drastically affect the advice you will receive and/or the outcome of your case. You do not need to list minor misdemeanors traffic infractions such as speeding, seat belt, red light charges, etc. Do not include the charge(s) you are here on.

Do you have any previous charges?
YesNo

Please send us all files relevant to your current case. You may send multiple files.

Help Us Improve Our Services

What are your most important goals/considerations in this case?

Referred By

Did you perform your search from a mobile device?
YesNo

Did you contact us after receiving our brochure in the mail?
YesNo

Search Engine

Directory

Phone Book

What is the primary reason you chose our firm?

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Information provided to us is protected by the attorney-client privilege, which extends to all of our office staff.
Any legal advice given is dependent upon the accuracy of the information you provide in this form.
Please make sure that the information you provide is complete and accurate.