Client Intake – Lutz Parish Gerrish

Client Intake Form

Your Name(Required)

First Name Last Name

Are you completing this form for yourself?(Required)

Yes

Prospective Client or Matter Name

Have we represented the prospective client before?

Yes

Unsure

Prospective Client Type(Required)

Urgent or Critical Dates, if any

Matter Type

Opposing Parties (List all known)

Brief Matter Summary

How can we get in touch?

Preferred Method of Contact(Required)

Your Email Address(Required)

Email Address Confirm Email Address

Your Address(Required)

Street Address Address Line 2 City Postal Code

Your Phone(Required)

Best Time to Call You(Required)