Client Intake Questionnaire - Criminal Defense

CLIENT INTAKE QUESTIONNAIRE — CRIMINAL DEFENSE

Law Firm: [________________________________]
Office Location: [________________________________]
Intake Date: [__/__/____]
Intake Conducted By: [________________________________]
Referred By: [________________________________]

CONFIDENTIALITY NOTICE: The information provided in this questionnaire is protected by the attorney-client privilege and work-product doctrine. Even if no engagement results, ABA Model Rule 1.18 imposes duties of confidentiality toward prospective clients. Please answer all questions as completely and accurately as possible. Incomplete or inaccurate information may adversely affect the representation.

SECTION 1: CLIENT PERSONAL INFORMATION

Note: Text messaging and email may not be secure or confidential. By selecting text or email, you acknowledge this risk.

Marital Status: ☐ Single ☐ Married ☐ Domestic Partnership ☐ Separated ☐ Divorced ☐ Widowed

Primary Language: [________________________________]
Interpreter Needed: ☐ Yes ☐ No — Language: [________________________________]

SECTION 2: EMERGENCY CONTACT

SECTION 3: CURRENT CHARGES AND CASE INFORMATION

Arrest / Citation Information:

Charges Filed (list all counts):

Additional charges anticipated: ☐ Yes ☐ No ☐ Unknown
If yes, describe: [________________________________]

SECTION 4: CUSTODY AND BAIL STATUS

Current Custody Status:
☐ In custody — Facility: [________________________________]
☐ Released on own recognizance (OR)
☐ Released on bail / bond
☐ Released with electronic monitoring
☐ Released to pretrial services
☐ Other: [________________________________]

Bail / Bond Information (if applicable):

Conditions of Release (check all that apply):
☐ No contact with alleged victim(s)
☐ Stay-away order (distance: [____] feet)
☐ No firearms possession
☐ Drug / alcohol testing
☐ Travel restrictions
☐ Curfew: [________________________________]
☐ Surrender passport
☐ GPS / electronic monitoring
☐ Check-in with pretrial services
☐ Other: [________________________________]

SECTION 5: NEXT COURT DATES AND DEADLINES

Statute of limitations concern: ☐ Yes ☐ No
Speedy trial deadline (if known): [________________________________]

SECTION 6: INCIDENT DETAILS

Important: Provide a truthful and detailed account. All information is protected by the attorney-client privilege.

Date of Alleged Incident: [__/__/____]
Time of Alleged Incident: [________________________________]
Location (full address): [________________________________]

Detailed Description of Events:
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]

Were other persons present during the incident? ☐ Yes ☐ No
If yes, list names and roles: [________________________________]

Were any weapons involved? ☐ Yes ☐ No
If yes, describe: [________________________________]

Were there any injuries (to anyone)? ☐ Yes ☐ No
If yes, describe: [________________________________]

Was alcohol or drug use a factor? ☐ Yes ☐ No
If yes, describe: [________________________________]

SECTION 7: MIRANDA AND LAW ENFORCEMENT CONTACT

Were you read your Miranda rights? ☐ Yes ☐ No ☐ Unsure
When were rights read (before or after questioning)? [________________________________]

Did you make any statements to law enforcement? ☐ Yes ☐ No
☐ Oral statements
☐ Written statements
☐ Recorded statements (audio or video)

Summary of statements made:
[________________________________]
[________________________________]

Did you request an attorney during questioning? ☐ Yes ☐ No
Did you invoke your right to remain silent? ☐ Yes ☐ No
Did questioning continue after you invoked rights? ☐ Yes ☐ No

Did law enforcement make any promises or threats? ☐ Yes ☐ No
If yes, describe: [________________________________]

Were you under the influence of any substance during questioning? ☐ Yes ☐ No
Were you experiencing any medical or mental health issues during questioning? ☐ Yes ☐ No
If yes, describe: [________________________________]

SECTION 8: SEARCHES, SEIZURES, AND EVIDENCE

Was a search conducted? ☐ Yes ☐ No

Evidence Known to Exist:
☐ Body camera footage
☐ Dashboard camera footage
☐ Surveillance video (business, residential, traffic)
☐ Photographs taken by police
☐ DNA / forensic evidence
☐ Breathalyzer / blood test results
☐ Cell phone records / data extraction
☐ Financial records
☐ Witness written statements
☐ 911 call recordings
☐ Other: [________________________________]

Do you have any evidence that may support your defense? ☐ Yes ☐ No
If yes, describe: [________________________________]

SECTION 9: WITNESSES

Prosecution Witnesses (known or anticipated):

Defense Witnesses (potential):

Alibi Information:
☐ Not applicable
☐ Alibi available — Details: [________________________________]
Alibi witness(es): [________________________________]

SECTION 10: PRIOR CRIMINAL HISTORY

Prior arrests or convictions? ☐ Yes ☐ No

Currently on probation or parole? ☐ Yes ☐ No
If yes, provide:

• Probation / Parole Officer Name: [________________________________]
• Contact Number: [________________________________]
• Terms and Conditions: [________________________________]
• Expiration Date: [__/__/____]

Pending cases in any jurisdiction? ☐ Yes ☐ No
If yes, describe: [________________________________]

Prior juvenile adjudications? ☐ Yes ☐ No
If yes, describe: [________________________________]

Sex offender registration requirements? ☐ Yes ☐ No

SECTION 11: IMMIGRATION STATUS

U.S. Citizen? ☐ Yes ☐ No

If not a U.S. citizen:

• Immigration Status: ☐ Lawful Permanent Resident ☐ Visa Holder (Type: [____]) ☐ DACA ☐ TPS ☐ Undocumented ☐ Other: [________]
• A-Number (if any): [________________________________]
• Pending immigration applications: ☐ Yes ☐ No
• Prior deportation or removal proceedings: ☐ Yes ☐ No

Immigration Consequences Notice: Criminal convictions may result in deportation, inadmissibility, or denial of naturalization. Under Padilla v. Kentucky, 559 U.S. 356 (2010), defense counsel must advise noncitizen clients of the immigration consequences of a guilty plea.

SECTION 12: EMPLOYMENT, EDUCATION, AND MILITARY

Professional Licenses at Risk:
☐ Medical ☐ Legal ☐ Teaching ☐ Commercial Driver ☐ Firearms ☐ Security Clearance
☐ Other: [________________________________]

Education:

• Highest Level Completed: ☐ Some High School ☐ GED ☐ High School Diploma ☐ Some College ☐ Associate's ☐ Bachelor's ☐ Graduate / Professional Degree
• Current Student: ☐ Yes ☐ No — School: [________________________________]

Military Service:
☐ None ☐ Active Duty ☐ Reserve ☐ National Guard ☐ Veteran

• Branch: [________________________________]
• Dates of Service: [________________________________]
• Discharge Type: ☐ Honorable ☐ General ☐ Other Than Honorable ☐ Dishonorable
• Eligible for Veterans Treatment Court: ☐ Yes ☐ No ☐ Unknown

SECTION 13: HEALTH AND MENTAL HEALTH

Current Physical Health Conditions: [________________________________]
Current Mental Health Diagnoses: [________________________________]
Current Medications: [________________________________]

Substance Use History:
☐ None
☐ Alcohol — Frequency: [________________________________]
☐ Prescription Medications (misuse) — Details: [________________________________]
☐ Controlled Substances — Type / Frequency: [________________________________]

Prior Treatment or Rehabilitation:
☐ Inpatient Treatment — Dates / Facility: [________________________________]
☐ Outpatient Treatment — Dates / Provider: [________________________________]
☐ 12-Step or Support Group Participation: ☐ Yes ☐ No

Eligible for Mental Health Court or Diversion? ☐ Yes ☐ No ☐ Unknown

SECTION 14: FINANCIAL INFORMATION AND FEE ELIGIBILITY

Annual Household Income: $[________________________________]
Household Size: [____]
Assets (real property, vehicles, savings): [________________________________]

Ability to Retain Private Counsel:
☐ Private retention — Retainer discussed: $[________________________________]
☐ Seeking court-appointed counsel (indigency)
☐ Pro bono referral needed

Has a public defender been appointed? ☐ Yes ☐ No
If yes, name: [________________________________]
Reason for seeking private counsel: [________________________________]

SECTION 15: CLIENT OBJECTIVES AND CONCERNS

Primary Objectives (rank in order of priority):
☐ Dismissal of all charges
☐ Acquittal at trial
☐ Reduction of charges
☐ Minimization of sentence
☐ Avoidance of incarceration
☐ Protection of immigration status
☐ Protection of professional license
☐ Expungement / sealing eligibility
☐ Diversion or deferred adjudication
☐ Other: [________________________________]

Immediate Concerns:
☐ Potential loss of employment
☐ Child custody / family impact
☐ Housing instability
☐ Travel restrictions
☐ Safety concerns (self or family)
☐ Media / publicity exposure
☐ Other: [________________________________]

SECTION 16: DOCUMENTS TO PROVIDE

Please provide copies of all available documents:

☐ Government-issued photo identification
☐ Citation, complaint, or indictment
☐ Bail / bond paperwork and conditions of release
☐ Court notices and scheduling orders
☐ Police reports and incident reports
☐ Search warrant and return
☐ Discovery materials received
☐ Prior court orders, probation terms, or sentencing documents
☐ Relevant photographs, videos, or recordings
☐ Medical records related to the incident
☐ Text messages, emails, or social media communications
☐ Character reference letters
☐ Employment verification / pay stubs
☐ Military service records (DD-214)
☐ Immigration documents (if applicable)
☐ Other: [________________________________]

SECTION 17: CONFLICT CHECK INFORMATION

List all individuals and entities involved in this matter (for conflict-of-interest screening per ABA Model Rules 1.7 and 1.9):

Have you or any family member previously been represented by this firm? ☐ Yes ☐ No
If yes, details: [________________________________]

SECTION 18: ACKNOWLEDGMENT AND AUTHORIZATION

By signing below, I acknowledge and agree to the following:

1. The information provided in this questionnaire is true and accurate to the best of my knowledge.
2. I understand that submission of this form does not create an attorney-client relationship. An attorney-client relationship is formed only upon execution of a written engagement agreement.
3. I understand that the information provided is treated as confidential under ABA Model Rule 1.18 (Duties to Prospective Client) regardless of whether representation is undertaken.
4. I authorize the law firm to conduct a conflict check using the information provided.
5. I understand that I should not destroy, alter, or delete any evidence, documents, or electronic communications related to this matter.
6. I have been advised that I have the right to remain silent and should not discuss the facts of my case with anyone other than my attorney.

Client Signature: [________________________________]
Date: [__/__/____]

Print Name: [________________________________]

FOR OFFICE USE ONLY

Sources and References

• ABA Model Rules of Professional Conduct, Rules 1.5, 1.6, 1.7, 1.9, 1.18
• Miranda v. Arizona, 384 U.S. 436 (1966) — Fifth Amendment right to counsel and silence during custodial interrogation
• Padilla v. Kentucky, 559 U.S. 356 (2010) — Duty to advise noncitizen clients of immigration consequences
• U.S. Const. amend. IV (Search and Seizure), amend. V (Self-Incrimination), amend. VI (Right to Counsel)
• ABA Formal Opinion 506 (2023) — Duties to Prospective Clients during intake by nonlawyer assistants
• National Legal Aid & Defender Association, Performance Guidelines for Criminal Defense Representation