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Contact Information
Your first name
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Your last name
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Your phone number
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Email address
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Are you contacting us on behalf of yourself or someone else?
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Myself
Someone else
Are you in a financial position to hire an attorney?
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🛈
Yes
No
Not sure
Have you spoken to other attorneys regarding this matter?
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Yes
No
If Contacting Us on Behalf of Someone Else (skip this section otherwise)
The name of the person
Your relationship to the person
Spouse (husband or wife)
Son or daughter
Boyfriend or girlfriend
Parent
Other family member
Friend
Does the person know you are contacting an attorney on their behalf?
Yes
No
Is the person currently incarcerated?
Yes
No
Personal Information of Potential Client
Legal name
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Aliases or AKA's if any
Date of birth
Prior contact with the criminal justice system?
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Yes
No
I don't know
Immigration status
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Citizen
Permanent Resident
Tourist Visa
Student Visa
Other Visa
Out of status
I don't know
Occupation
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Are there any licenses or special considerations that need to be taken into account because of the potential client’s occupation, e.g., attorney, physician, state or federal license?
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Yes
No
Please explain
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Nature and Location of Case
Is this a state or federal case?
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State
Federal
I don't know
What city and county is this taking place in?
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Has there been an arrest in this case?
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Yes
No
What was the date of the arrest?
Has there been a court date yet in this matter?
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Yes
No
I don't know
If you have a case number from the court, please write it here
Please take a moment to describe the situation and / or case (the more details, the better)
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Feel free to provide us with any materials you feel would assist us in evaluating your case, e.g., arrest report, court documents, photos, etc.
How did you hear about us?
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Reputation
Referral
Legal Guide (i.e., SuperLawyers Magazine)
Facebook
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Other
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