Client Intake Questionnaire (Criminal Defense)

1. Client Information

• Full legal name:
• Preferred name/pronouns:
• Date of birth:
• SSN/Tax ID (if needed):
• Residential address:
• Mailing address (if different):
• Primary phone:
• Alternate phone:
• Email address:
• Preferred communication method (phone/email/portal/text): Text messaging may not be confidential.

2. Emergency Contact

• Name:
• Relationship to client:
• Phone:
• Email:

3. Arrest/Case Information

• Date of arrest/citation:
• Arresting agency:
• Booking number / case number:
• Charges filed (list all):
• Court name and jurisdiction:
• Next court date/time:
• Current bond/bail amount and conditions:
• Custody status: ☐ In custody ☐ Out on bond ☐ Released on own recognizance

4. Incident Overview

• Date/time of alleged incident:
• Location:
• Brief description of what happened:
• Names of officers or witnesses (if known):
• Were statements made to law enforcement? ☐ Yes ☐ No
• If yes, describe:

5. Searches, Seizures, and Evidence

• Was there a search? ☐ Yes ☐ No
• Consent given? ☐ Yes ☐ No ☐ Unknown
• Search warrant? ☐ Yes ☐ No ☐ Unknown
• Evidence seized (list):
• Body cam / dash cam / surveillance? ☐ Yes ☐ No ☐ Unknown
• Written or recorded statements? ☐ Yes ☐ No ☐ Unknown

6. Prior Record

• Prior arrests or convictions? ☐ Yes ☐ No
• If yes, list dates, charges, outcomes:
• Pending cases or probation/parole? ☐ Yes ☐ No
• If yes, details:

7. Immigration Status (if applicable)

• U.S. citizen? ☐ Yes ☐ No
• If not, status (visa, lawful permanent resident, etc.):
• Prior immigration proceedings? ☐ Yes ☐ No

8. Employment and Background

• Employer and position:
• Work schedule:
• Professional licenses at risk:
• Military service: ☐ Yes ☐ No

9. Potential Witnesses and Evidence

• Witness names and contact info:
• Photos/videos available? ☐ Yes ☐ No
• Texts/emails/social media relevant? ☐ Yes ☐ No
• Alibi information (if applicable):

10. Objectives and Concerns

• Desired outcome:
• Immediate concerns (custody, employment, travel restrictions):
• Safety concerns or protective orders:

11. Documents to Provide

☐ Citation or complaint
☐ Bail/bond paperwork
☐ Court notices
☐ Police report (if available)
☐ Discovery received
☐ Prior court orders/probation terms
☐ Other documents: ________________________

12. Acknowledgment

• I certify that the information provided is accurate to the best of my knowledge and understand that submission does not create an attorney-client relationship until a written engagement agreement is signed.

Client signature: ____________________________ Date: __________

Intake received by (staff): ____________________ Date: __________