Criminal Defense Intake Form

1

First Name* This field is required.

2

Last Name* This field is required.

3

Mobile Phone* This field is required.

Please enter a valid phone number.

4

Email

example@example.com

5

Type of Case* This field is required.

6

County* This field is required.

7

Have you been arrested?* This field is required.

Yes

No

8

Court Date (if applicable)

Date

9

Is potential Client in jail* This field is required.

Yes

No

10

Is this your first criminal case?* This field is required.

Yes

No

11

Are you represented by another attorney?* This field is required.

Yes

No

12

Are there co-defendants involved?* This field is required.

Yes

No

13

Preferred contact method* This field is required.

Phone

Email

Text message

Other

14

Best time to call

15

How soon do you need to speak with an attorney?* This field is required.

Immediately

Within 24 hours

Within 2–3 days

Within a week

No rush

16

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17

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