Intake Form
Kindly complete this form and click the SUBMIT button at the bottom. Thank you.
Business Name: (if applicable)
*
Client Name
*
First Name
Last Name
This Scheduled Consult is Being Held
*
In Person
Over the Phone
Via Zoom
Date of Scheduled Consult
*
-
Month
-
Day
Year
Date
Time of Scheduled Consult
*
Hour Minutes
AM
PM
AM/PM Option
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Social Security #
Matter Type
*
Corporate Consulting
Business Formation
General Business Matters
Employment
Owner Dispute
Lease
Sale/Purchase (APA)
Bankruptcy
Litigation
HIPAA
Health Care
Trademark
Collections
Contract Review
Real Estate
Other
Is there an opposing (adverse) party?
*
Yes
No
Name of opposing (adverse) party:
Names of all other related parties:
How did you hear about us?
*
Please Select
Internet Search
News & Record
Website
Social Media
Previous client
Attorney Referral
CPA Referral
Legal Match
Medical Resident
Other
Name of person referring you (if applicable):
Please feel free to share with us any other details you would like us to know so that we can best serve your needs.
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Date Submitted
-
Month
-
Day
Year
Date
For Office Use Only:
Retainer Requested: Y/N Amount: $________________ Rate: Hourly or Flat Fee ($______________) Originating Attorney: KMS CSM RR BS RA
How would you like to be contacted for your Initial Consultation?
*
Email
Text
Phone Call
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