Criminal Law Intake Form
Contact Number
Contact Number
Contact Number
Contact Number
"Before we get started, please keep in mind we do NOT give any type of legal advice. We only bring lawsuits."
**Wait for a response. **
"Thank you for your time. Unfortunately, there's not much we can do at this time but if you do change your mind, please do not hesitate to contact us."
IF THE ANSWER IS NO, READ THIS.
Back
Next
Name of Person Doing the Intake
Date
-
Month
-
Day
Year
Date
Client Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Preferred Language:
Gender
Male
Female
Back
Next
Employment Details
Occupation
For how long?
Race/Ethnicity you identify yourself with:
Nationality
Employer's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Any limitations on contacting you (Email not secure? Cell phone not secure? Etc.)
Driver’s State/License#_
Social Security #
Educational Background
Served in the Armed Forces
Civil Status
If you have children, how many?
Whom the children live with?
What, if there's any medications you take
Have you ever received mental health or substance abuse counseling?
Name of Significant Other
Relationship to you
Living in the same address?
How Long?
Contact Number (Significant Other)
Back
Next
Arrest Information
City and Country of Arrest
Booking #
Date of arrest and charge (include Code section, if known)
Date & location of alleged crime
Court Name, Court Date, and Time
Arresting Officer’s Name & badge number (if available)
Was anyone else arrested? If so, name everyone else that was arrested.
What statements did you make to law enforcement?
Have you discussed the crime with anyone else? Yes/No
Describe the order of events leading up to the arrest
List any witnesses to the alleged crime if known
List any alibi witnesses
What is the amount of bond you posted?
List any special bond conditions
List prior arrests/charges, date, and what the final outcome was:
Are you currently on probation or parole? For which offense?
Name of parole or probation officer
Office location of Probation officer
COMMENTS THAT MAY BE OF VALUE TO YOUR CASE
Should be Empty: