Prospective Client Data Sheet

The purpose of this form is to collect some preliminary information regarding your case so we can determine if it is something we can assist you with and whether or not you have any upcoming court dates. We will contact you if we have any additional questions. If a question does not apply, please put N/A. If the form request a date and a date does not apply, please use the date you are completing the form to answer the question. Upon completion of this form, someone you will hear from our office within 1-3 business days to schedule an appointment or otherwise tell you if we can assist you. Thank you for completing this form. We look forward to working with you.

PLEASE NOTE THAT COMPLETING THIS FORM IS NOT AN AGREEMENT OR GUARANTEE THAT WE WILL BE ABLE TO PROVIDE YOU WITH LEGAL REPRESENTATION.

Contact information

Prefix

First name *

Middle name

Last name *

Company

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Prospective Client Data Sheet

Contact information

New or Existing Client

How did you hear about our firm?

If other state type of case here

My case is in

Please classify your urgency in concluding this matter:

I have an Upcoming Court Date

Other Specific Date/Deadline Requirements if any

Opposing Parties Names for Conflicts Check

Is the Opposing Party Represented by Counsel?

If yes, if you know the Opposing Party's attorney's name, please list it here.

Date the Incident Occurred (Injury/Medical Malpractice/Contract Signed/Contract Breached)

Brief Statement of Situation

This form was completed by the prospective client

This form was completed by LRB

THANK YOU

The Current Problem is: (check all that apply)