Client Intake & Conflict Check Form
Share the details of your legal matter so we can assess your needs and run a conflict check.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
County of residence
What type of legal assistance do you need?
*
Estate Planning
Divorce & Family Law
Business Law
Prenuptial or Postnuptial Agreement
Personal Injury (Auto Accident)
Personal Injury (Dog Bite)
Other
Adverse Party Information
*
Briefly describe your legal issue or question
*
Please list the names of any other parties involved (for conflict check)
Does anyone involved in the personal injury matter have insurance?
*
Yes
No
Not applicable
Case # if one exists
SUBMIT
Should be Empty: