DeKalb County Legal Clinic Intake Form

DeKalb County Legal Clinic Intake Form
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Client Information
Full Name

First NameLast Name
Any Other Names Used
Date of Birth
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Opposing Party's Information
Full Name

First NameLast Name
Any Other Names Used
Date of birth
County of Residence
Will this party sign the documents?
Legal Issue Information

Check all that apply
Type of Legal Issue
Brief Description of Legal Issue:
Conflict Check Authorization
I understand that the legal clinic will perform a conflict of interest check before providing services.
Disclaimer and Consent
I understand that:

• This clinic may provide brief advice and/or limited services only.
• Completing this form does not create an attorney-client relationship until confirmed.
• All information provided is true and accurate to the best of my knowledge.
• This clinic is a one-time 30-minute consultation.
• This clinic does not provide legal advice on adoptions, criminal matters, real estate matters,
personal injury, probate matters, or appellate-level cases.
Signature
Should be Empty:

Client Information