Online Intake Form

1
What type of case do you have?Please select all that apply.
I have been charged with a DWI.
I have a drug case.
I have been charged with felony.
I have been charged with a misdemeanor.
2
Name
First Name
Last Name
3
Email
example@example.com
4
Phone Number
Area Code
Phone Number
5
How do you prefer to be contacted?
Email
Telephone
6
What city or county were you arrested or charged in?
7
Do you already have a lawyer?
YESNO
8
Is there anything else you feel that we should know. (This is 100% confidential)
Huge
Large
Normal
Small
Ok
Ok
9
Appointment
10
How did you hear about us? examples: Google, Facebook, Instagram, Referral
Should be Empty: