localelaw_intake

1. Contact Information

Full Name

Phone Number

Email Address

example@example.com

Preferred Contact Method

PhoneEmailEither

Best Time to Contact

MorningMiddayEveningAny time

2. Location & Incident Details

(if applicable)

Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Incident (if applicable)

Date

Incident Location (if applicable and different from above)

3. Legal Need

Type of Attorney Needed

Brief Case Description/Facts

Opposing Party (if known)

Is a lawsuit already filed?

Upcoming Deadlines Court Dates (if applicable)

Date

Have you consulted or engaged another attorney?

YesNo

4. Damages / Financial Info (if applicable)

Estimated Damages Claim Value (if applicable) ($USD)

Medical Treatment Costs Incurred (if applicable) ($USD)

Name of Insurance Company Involved (if applicable)

5. Verification & Consent

I consent to be contacted by phone, SMS, or email by Locale Law and its partner attorneys for the purpose of evaluating my legal matter. I understand that submitting this form does not create an attorney-client relationship. I understand that Locale Law may refer my information to an attorney and or third-party service and may receive compensation for that referral.

Signature

Date

Locale Law LLC is a lead generation service, not a law firm, and does not provide legal advice.

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