Woods Law Client Intake Form

MyselfSomeone else (i.e. parents, other relative)Estate or Trust
Relation to Client:*
Client Name (First, Middle and Last):*
(If you are here on behalf of someone (i.e. parents, other relative), please put their information here)
Spouse/Other Name (First, Middle and Last):
Address: *
City:*
Zip Code:*
Preferred Phone:*
Alternative/Spouses Phone:
Email Address:
Marital Status:*
(VA Requires Information On All Current/Past Marriages)
Date Of Birth Client:*

MonthDayYear
Date
Date of Birth Spouse/Other:

MonthDayYear
Date
How did you hear about us? *
Referral (First and Last Name):
Is Client/Spouse A Veteran or Surviving Spouse?*
Family Contacts
First, Middle and Last Name:/Relation:*
Address:*
Phone:*
Email:*
First, Middle and Last Name/Relation:
Address:
Phone:
Email:
First and Last Name/Relation:
Address:
Phone:
Email:
First, Middle and Last Name/Relation:
Address:
Phone:
Email:
ASSETS
INCOME
DEBTS
Initial consultation fee due at check-in

We accept check, cash

Cancellation/Reschedule fee of $50 will be assessed to reschedule appointments for clients who do not give 24-hour notice of cancellation
Should be Empty:

Family Contacts