Pre-Intake Form

Pre-Intake Form
Date

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
"Hola, gracias por llamar. Quiero asegurarte que todo lo que compartas con nosotros es completamente confidencial y se mantendrá entre nuestra oficina y tú. Tu privacidad es muy importante para nosotros, y contamos con medidas estrictas para proteger tu información. Este formulario tomará aproximadamente 5-10 minutos para completarlo. Le agradecemos su paciencia y gracias por llamarnos. Cada pregunta que responda será ingresada en nuestro sistema.
Name*

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location of Client
City in where the client is calling from.
How did you hear about us?*
What Type of Case Are You Calling About?*
Immigration Information of Client
Date of Entry

MonthDayYear
The "date of entry" for immigration is the day a person officially enters and is recorded by immigration authorities in a country, starting the timeline for any visa or residency conditions.
Where did you first enter the U.S.?
This question asks for the specific location where you first entered the United States to establish your initial point of entry and begin tracking your immigration journey.
Do you have an Alien Registration Number?

NoYes
What is your Alien Registration Number
This question inquires whether you possess an Alien Registration Number, which is a unique identifier assigned to non-citizens by U.S. immigration authorities for tracking and record-keeping purposes.
What country are you originally from?
This question seeks to determine your country of origin, providing context about your nationality and initial citizenship.
Did you enter the country with any family members?

NoYes
Which of the following methods did you use to enter the country

VisaVisa Waiver ProgramPermanent Resident Status/Green CardRefugee or Asylee StatusBorder CrossingDiplomatic EntryUnauthorized/Undocumented EntryOther
Were you detained by ICE or U.S. Customs and Border Protection (CBP)

YesNo
If yes, how long were you detained for?
"Do you currently have a tracking device, such as an electronic ankle monitor, placed on you by immigration authorities? If so, what type of device is it?"*
GPS Ankle Monitor: A device worn around the ankle that uses GPS technology to track location.RF (Radio Frequency) Ankle Monitor: Less common, this device monitors a person's movements within a certain range, often used for house arrest scenarios.SmartLINK App: A smartphone application that immigrants can use to check-in and communicate with immigration officials, tracking their location and compliance.These are the primary types of tracking devices used by immigration authorities for monitoring individuals under their supervision.
What reason for entry did you provide during your interview with U.S. Immigration and Customs Enforcement (ICE)?

Family ReunificationEmploymentAsylum or RefugeMedical TreatmentOther
Do you have a Notice to Appear (NTA) or any upcoming court hearings related to your immigration case?

YesNo
If yes, when is your next appointment.

MonthDayYear
Date
Do you have a scheduled Master Hearing appointment for your initial immigration court appearance?

YesNo
If yes, when is your next appointment

MonthDayYear
Date
Do you have a scheduled Second Master Hearing appointment for your immigration court appearance?

YesNo
If yes, when is your next appointment

MonthDayYear
Date
Have you filed a motion to change, close, or reopen your immigration case, or to update your address with the court?
A motion may be filed in an immigration case when an individual needs to update their legal proceedings due to changes in circumstances, new evidence, or errors in the initial process, or when they need to correct personal information like an address.
Are you currently in the United States under a parole status?
While parole is a temporary measure, it allows the individual to stay in the U.S. and may enable them to apply for an Employment Authorization Document (EAD), which grants the right to work during their stay (U.S. Customs and Border Protection) (American Immigration Council).
Are you currently using the CBP One mobile application for any of your immigration or entry processes?
The CBP One application helps facilitate the process of obtaining parole by enabling individuals to submit their information, schedule appointments, and complete necessary pre-screening processes before arriving at a port of entry. This app is particularly useful for managing the entry of asylum seekers and other migrants who may qualify for parole (American Immigration Council) (National Immigration Forum).
If you are currently in the United States under a parole status, please specify the type of parole. (Optional)

Humanitarian Parole: This is granted to individuals who need to enter the U.S. for urgent humanitarian reasons, such as medical emergencies or to reunite with family members in crisis (U.S. Customs and Border Protection) (National Immigration Forum).Public Benefit Parole: This is granted when an individual’s entry is determined to be in the public interest, such as for participating in legal proceedings or contributing to important public projects.Advance Parole: This allows individuals who are already in the U.S. under certain statuses, such as those with pending adjustment of status applications, to leave and re-enter the country without abandoning their application (U.S. Customs and Border Protection) (National Immigration Forum).Other
Can you provide a summary of your immigration case or describe your current situation?
Understanding your immigration case or story is important because it provides critical context and details needed to effectively assist you with your legal proceedings and to advocate for your rights and needs.
For Those Who Receive The Call From Herbert Law Group
Was a Consultation Schedule?*

YesNo
If no, Why
Is your next appointment in the office or over the phone?

At the officeOver the phone
Next Appointment Date

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
Who will be consulting the client?
Where was the appointment registered?

Outlook CalenderCallrailFilevineSpreedsheet
Should be Empty:

Pre-Intake Form

Immigration Information of Client

For Those Who Receive The Call From Herbert Law Group