Free Intake Form
This Intake Form used by an attorney when first interviewing a prospective client. This form contains all pertinent information about the client including all contact and insurance information. This Intake Form also includes information regarding other attorneys who were consulted, legal notices received, identity of any witnesses, relevant case documents and how the client chose the attorney.
Disclaimer:This was not drafted by an attorney & should not be used as a legal document.
INTAKE FORM
1. Name: _______________________________
2. Addresses
Home: _______________________________
_____________________________________
Business: ______________________________
______________________________________
Billing: ________________________________
______________________________________
3. Telephone numbers
Home: _______________________________
Work: _______________________________
Fax number: _______________________________
4. Employer: _______________________________
5. Occupation: _______________________________
6. Date and place of birth: _______________________________
7. Driver's license number: _______________________________
8. Social security number: _______________________________
9. Citizen: _______________________________
10. Spouse's information
Name: _______________________________
Date and place of birth: _______________________________
Date of marriage: _______________________________
Work address: _______________________________
Work telephone number: _______________________________
11. Insurance information
Name of insurance agent: _______________________________
Home insurance coverage: _______________________________
Vehicle insurance coverage: _______________________________
Medical insurance coverage: _______________________________
Other: ___________________________________________________
12. Any other Attorneys you have ever consulted regarding this case: ____________________________________________________________________________
13. Any notices you been served concerning this case: _______________________________
______________________________________________________________________________
14. Any documents you have relating to this case: _______________________________
________________________________________________________________________________
15. Identify any witnesses or people with knowledge of the facts of this case: _________________________________________________________________________________
16. Any statements concerning this case: _______________________________________________
_________________________________________________________________________________
17. How did you choose our firm: ______________________________________________________
__________________________________________________________________________________
The forms on this site are provided "As-Is." By using these forms you agree that you are using them at your own risk. Most of the free forms are not prepared by an attorney and may need substantial modification. Additional disclaimers can be found in our Terms of Use.