Client Intake Form — General

CLIENT INTAKE FORM — GENERAL

Table of Contents

1. Intake Information
2. Prospective Client Information
3. Matter Information
4. Adverse and Related Parties
5. Conflict Check
6. Engagement Screening
7. Financial Screening
8. Referral and Marketing
9. Confidentiality Notice
10. Intake Decision

1. Intake Information

Date of Inquiry: [__/__/____]

Intake Completed By: [________________________________]

Method of Contact: ☐ Phone ☐ Email ☐ Walk-in ☐ Website Form ☐ Referral ☐ Other: [________]

Consultation Scheduled: ☐ Yes — Date/Time: [________________________________] ☐ No

2. Prospective Client Information

Individual Client

Full Legal Name: [________________________________]

Also Known As / Former Names: [________________________________]

Date of Birth: [__/__/____]

Social Security Number (last 4): XXX-XX-[____]

Driver's License / State ID Number: [________________________________]

Address: [________________________________]

City, State, ZIP: [________________________________]

Home Phone: [________________________________]

Cell Phone: [________________________________]

Email: [________________________________]

Preferred Contact Method: ☐ Phone ☐ Email ☐ Text ☐ Mail

Preferred Language: [________________________________]

Employer: [________________________________]

Occupation: [________________________________]

Business / Entity Client

Entity Name: [________________________________]

Entity Type: ☐ Corporation ☐ LLC ☐ Partnership ☐ Nonprofit ☐ Government ☐ Other: [________]

State of Formation: [________________________________]

EIN: [________________________________]

Principal Office Address: [________________________________]

Authorized Contact Person: [________________________________]

Title / Role: [________________________________]

3. Matter Information

Brief Description of Legal Issue:

[________________________________]
[________________________________]
[________________________________]

Practice Area: ☐ Family Law ☐ Criminal Defense ☐ Personal Injury ☐ Real Estate ☐ Business / Corporate ☐ Estate Planning ☐ Employment ☐ Immigration ☐ Bankruptcy ☐ Landlord/Tenant ☐ Civil Rights ☐ Other: [________________________________]

Urgency Level: ☐ Emergency (immediate deadline) ☐ Urgent (within 30 days) ☐ Standard ☐ Planning / No immediate deadline

Key Dates / Deadlines:

Has the client consulted with or retained another attorney for this matter?
☐ No ☐ Yes — Attorney Name: [________________________________] Firm: [________________________________]

Is there pending litigation? ☐ No ☐ Yes — Case No.: [________________________________] Court: [________________________________]

4. Adverse and Related Parties

Opposing Counsel (if known): [________________________________]

Insurance Company (if applicable): [________________________________]

5. Conflict Check

Conflict Check Performed By: [________________________________]

Date of Conflict Check: [__/__/____]

Database(s) Searched:
☐ Firm conflict database / case management system
☐ Name variations and aliases checked
☐ Entity affiliates and subsidiaries checked

Results:

☐ No conflict identified — proceed to engagement screening
☐ Potential conflict identified — details: [________________________________]
☐ Conflict exists — cannot represent; decline and provide referral

If conflict is waivable under MRPC 1.7(b):
☐ Conflict waiver obtained (attach signed waiver)
☐ Conflict waiver not sought — matter declined

6. Engagement Screening

Screening Criteria:

☐ Matter falls within the firm's practice areas
☐ The firm has capacity to handle the matter within required timelines
☐ The client's expectations are reasonable and manageable
☐ The fee arrangement is viable (contingency worthiness / client ability to pay)
☐ No red flags identified (see below)

Red Flag Assessment:

☐ Client has fired multiple prior attorneys
☐ Unrealistic expectations about outcome or timeline
☐ Potential for fee collection issues
☐ Client may be seeking assistance with fraudulent or illegal activity
☐ Statute of limitations has already expired
☐ Significant credibility concerns
☐ Other: [________________________________]

7. Financial Screening

Estimated Fee Range Discussed: $[________] to $[________]

Fee Structure Discussed: ☐ Hourly ☐ Flat Fee ☐ Contingency ☐ Hybrid ☐ Other

Can the client afford the anticipated fees? ☐ Yes ☐ Uncertain ☐ No — consider referral to legal aid

Retainer Amount Discussed: $[________________________________]

Payment Plan Needed: ☐ No ☐ Yes

8. Referral and Marketing

How did the client hear about the firm?

☐ Referral from: [________________________________]
☐ Website / Online search
☐ Social media
☐ Bar association referral service
☐ Advertising
☐ Returning client
☐ Other: [________________________________]

9. Confidentiality Notice

The information provided in this intake form is confidential and protected by the attorney-client privilege and MRPC 1.6, even if the firm does not ultimately accept the representation. See MRPC 1.18 regarding duties to prospective clients.

Client Acknowledgment: ☐ Client informed of confidentiality protections

10. Intake Decision

Decision: ☐ Accept — proceed with engagement letter ☐ Decline — send non-engagement letter ☐ Defer — pending: [________________________________]

If declined, reason: [________________________________]

Referrals provided: [________________________________]

Non-engagement letter sent: ☐ Yes — Date: [__/__/____] ☐ N/A

Deciding Attorney: [________________________________]

Date: [__/__/____]

Sources and References

• ABA Model Rule 1.7 — Conflicts: Current Clients
• ABA Model Rule 1.18 — Duties to Prospective Clients
• ABA Model Rule 1.6 — Confidentiality