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Client Intake Form 

Client Intake Form 

INSTRUCTIONS: Answer all questions truthfully and completely. The information you enter in this questionnaire is confidential and protected by Attorney-Client Privilege. Subject to the terms and conditions for use of electronic forms, the information will not be disclosed to anyone outside of this office, except in the course of rendering legal services on your behalf, or unless otherwise required by law.
12Questions
  • 1
    Please enter your full name 
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  • 2
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  • 3
    Please enter the address where you receive mail
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    • Afghanistan
    • Albania
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    • Andorra
    • Angola
    • Anguilla
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    • Argentina
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    • Denmark
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    • Iran
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    • Mexico
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    • Namibia
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    • Nepal
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    • New Caledonia
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    • Northern Mariana
    • Norway
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    • Pakistan
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    • Philippines
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    • Poland
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    • Puerto Rico
    • Qatar
    • Republic of the Congo
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    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
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    • Saint Lucia
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    • Saint Vincent and the Grenadines
    • Samoa
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    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
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    • South Africa
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    • Spain
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    • eSwatini
    • Sweden
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    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
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    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 4
    Preferred phone
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  • 5
    Do you give GILLETT LAW, APC permission to text message the phone number you provided and agree to incur any related charges imposed by your carrier? 
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  • 6
    In the case of an emergency, you are authorizing GILLETT LAW, APC to contact the person below and divulge that we are attorneys who need to discuss a matter with you
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  • 7
    Please indicate what type of matter you are seeking legal advice on: 
    • Adoption
    • Family Law - Divorce
    • Family Law - Child Custody/Support
    • Special Education
    • Education - Other
    • Guardianship/Conservatorship
    • Criminal
    • Domestic Violence Restraining Order
    • Juvenile - Delinquency
    • Juvenile - Dependency
    • Other
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  • 8
    Please provide a brief description of the matter.
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  • 9
    Please provide information regarding the opposing party in this matter.  If it a criminal or juvenile matter please put the county in which the matter is being heard.
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  • 10
    If there is already a case filed, please provide information below. If there is no case filed, please select NEXT
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    • Tulare
    • San Luis Obispo
    • Fresno
    • Kern
    • Santa Barbara
    • Monterey
    • Other
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  • 11
    How did you hear about our office? 
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  • 12
    Terms: Although GILLETT LAW, APC makes all efforts to maintain strict security as it related to submission of electronic data, we do not in anyway guarantee that the information delivered in this form cannot be accessed by those who seek to unlawfully obtain access. Therefore, if you choose to proceed with using this form, you are doing so at your own risk and waive any claims that may arise out of the use of this form.  Further, you agree to release and hold harmless GILLETT LAW, APC, its shareholders, associates and all related parties.  If you do not agree to the terms, please do not submit this form and contact the office immediately to obtain a paper copy of the intake sheet. TO PROCEED, PLEASE CHECK BELOW:
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