CRIMINAL CASE INTAKE SHEET
Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Client's Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
State
*
ZIP
*
Client Date of Birth
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Client Social Security Number
Home Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Alt. Phone
Format: (000) 000-0000.
Employer
Employer Phone Number
Format: (000) 000-0000.
Emergency Contact Name
Emergency Contact Phone Number
Relationship
Contact's Address
Date of Incident
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Charges
*
Is client on probation?
Prior felonies? (date)
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is client currently incarcerated?
If so, what bond?
Court Room
Cause Number
Next Court Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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