Confidential Intake Form

Date of birth?

MM

DD

YYYY

Is that phone number

A cell number?

A work number?

Is that address

A physical address?

A home address?

A work address?

What are you interested in speaking to us about? *

General legal representation for your business

Business consulting for your business

Legal representation in a pending dispute

Other

Have you spoken to an attorney about this matter before? *

Yes

No

Please classify your urgency in concluding this matter *

Critical – Personal safety or continuation of business depends on it

Very important – Severe personal or financial hardship if not resolved quickly

Important – Matter interferes with business or personal financial stability

Priority - Needs to be done, but no immediate hardship in the interim

Concerned - Think it is worth pursuing, but not counting on anything

Curious - Want to know your rights and have an opportunity to weigh your options.

Disclaimer & Acknowledgement *

During your initial consultation, we will discuss our fees and how you can retain us. If you wish to hire us, and we choose to undertake your representation, it must be under the terms of that retainer agreement. We do not represent you unless and until we both finalize a retainer agreement. If your matter involves a potential lawsuit, you may lose your case as a matter of process if you fail to act within a specific period of time, regardless of whether you were right or wrong. Therefore, if you choose not to retain us, or if we decline representation, we strongly urge you to immediately consult with another attorney to protect your rights. By submitting this intake form, you acknowledge that you have read this disclaimer, answered these questions truthfully, and understand that this does not mean you have hired an attorney.

I understand and accept