Client Intake Questionnaire

Prospective Client Questionnaire
I am seeking legal representation related to:

Gun Rights RestorationConcealed Weapons LicensePurchase DenialConstitutional Rights ViolationFBI Voluntarily Appeal FileRisk Protection OrderConstructive Possession Legal OpinionGun TrustOther
Full Name*

First NameMiddle NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Birth Date*

MonthDayYear
Have you been convicted of or had any of the following entered against you? Complete the information below for all that apply.

Felony in FloridaMM Domestic Violence -FloridaDishonorable DischargeInjunction - ViolenceInjunction - StalkingOut of State ConvictionFederal ConvictionMarchman Act CommitmentBaker Act CommitmentRisk Protection OrderOther
Please complete the sections that apply:
- Did you loose your gun rights due to a Felony or Misdemeanor Domestic Violence conviction?
  
  FelonyDomestic ViolenceOther
- Have your Civil Right been restored? This includes the right to Vote, Sit on a Jury and Hold Public Office.
- County & State of Charge and/or Conviction*
- What were you charged with?
- Approximate Date of Arrest or Conviction
- What were you CONVICTED of?
- What was your sentence?
  Including time served, probation, fines, fee and court costs
- Was adjudication withheld?
  Yes or No
- Month/Year All Terms of Sentence Completed (including financial obligations):
  The date or estimated date that you completed all terms of your sentence. Paying fines, fees, restitution, and court costs are included. This date could be when you completed probation, finished required classes, etc.
- Any additional information you wish to share, please share it here.
- Upload Criminal History Documents
  
  Browse Files
  
  Cancelof
- Briefly explain the circumstances of the civil injunction. When and where? What was the injunction for (i.e. stalking, violence)? Was it temporary or permanent? If temporary, when did it expire. What is the current situation with the person who had the injunction against you? Please upload any documents you have.
- Injunction Petitioner
  Name of the person who sought the Injunction
- County, State
- Approximate Date of Injunction
- Upload Injunction Documents
  
  Browse Files
  
  Cancelof
- Briefly describe the circumstances of your CWL Application denial or suspension. Please upload all documents you have, specifically the Suspension or Denial Letter and criminal history report they attached to it.
- Date of Suspension/Denial Letter
- Upload CWL Denial/Suspension Documents
  
  Browse Files
  
  Cancelof
- Briefly describe the circumstances of your purchase denial or hold. When and where did you attempt to purchase? Have you been denied a purchase before? Do you have any criminal history, either in Florida or another state, that you think might be causing the problem? Did you receive a Transaction Number (NTN) from the Dealer? Please upload all documents you have and enter the NTN below.
- Purchase Transaction Number (NTN) provided by the FFL (Dealer)
  This number should have been provided by the dealer from whom you attempted to purchase. If they didn't give you one, call and ask for it.
- Upload Purchase Denial Documents
  
  Browse Files
  
  Cancelof
- Briefly describe why the Risk Protection Order was filed, on what date and by which law enforcement agency. Have you had a hearing? If so, when. Please upload all document below.
- Date of Prior Hearing
- Date of Scheduled Hearing
- Upload RPO Documents
  
  Browse Files
  
  Cancelof
- Briefly describe why you were discharged dishonorably, when and from which branch of the Armed Forces. If you have your DD214 or any Court Martial documents, please upload them.
- Branch of the Armed Forces
- Date of Discharge
- Upload Discharge Documents
  
  Browse Files
  
  Cancelof
- Briefly describe the circumstances under which your firearms were confiscated. When did this occur? What actions have you already taken to try and get them back. If you have any documents, please upload them.
- Please list the confiscated firearms (Make/Model only)
- Which agency has your firearms?
- Upload Firearms Confiscation Documents
  
  Browse Files
  
  Cancelof
- Briefly describe the circumstances under which you were committed for mental health or substance abuse treatment. Specify whether it was under the Marchman Act (substance abuse) or Baker Act (mental health). If you have any documents, please upload them.
- Upload Marchman/Baker Act Documents
  
  Browse Files
  
  Cancelof

Prospective Client Questionnaire