Client Intake Questionnaire (General Practice)

1. Client Information

• Full legal name:
• Preferred name/pronouns:
• Date of birth:
• Social Security Number/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 number:
• Email address:

3. Matter Overview

• Type of legal issue (check all that apply):
• ☐ Business/Corporate
• ☐ Civil Litigation
• ☐ Criminal Defense
• ☐ Family Law
• ☐ Estate Planning/Probate
• ☐ Real Estate
• ☐ Employment
• ☐ Other: __________
• Brief description of issue and desired outcome:
• Relevant deadlines or court dates:
• Opposing parties or entities involved:
• Prior or related legal matters:

4. Prior Counsel

• Have you previously consulted or retained another attorney regarding this matter? ☐ Yes ☐ No
• If yes, attorney name and firm:
• Reason for seeking new counsel:
• Date representation ended:

5. Financial Information (if applicable)

• For individuals:
• Employer and occupation:
• Annual income:
• Household size/dependents:
• For businesses:
• Entity type:
• Annual revenue:
• Number of employees:
• Key decision makers:

6. Documents and Evidence

• List of documents currently available (contracts, court papers, correspondence, financial records, etc.):
• Location of additional documents or electronic data:
• Witness names and contact information:

7. Adverse Parties and Conflicts Check

• Names of individuals, companies, or agencies involved on opposing side:
• Affiliations or relationships relevant to conflict analysis:
• Have you or any related parties previously been represented by our firm? ☐ Yes ☐ No

8. Insurance Coverage

• Do you have insurance that may cover this matter (e.g., liability, homeowner, malpractice)? ☐ Yes ☐ No
• If yes, insurer and policy number:
• Date claim reported:

9. Criminal/Regulatory History (if applicable)

• Prior arrests, charges, or convictions:
• Pending investigations or administrative proceedings:

10. Additional Information

• Special accommodations needed (language access, disability, scheduling):
• How did you hear about our firm?
• Other facts or concerns not covered above:

11. Document Upload Checklist (attach copies where possible)

• ☐ Identification (driver’s license, passport)
• ☐ Relevant contracts/agreements
• ☐ Court pleadings/notices
• ☐ Financial statements/pay stubs/tax returns
• ☐ Correspondence/emails
• ☐ Photographs/video/audio evidence
• ☐ Medical records/bills (if applicable)
• ☐ Insurance policies/claim documents
• ☐ Other supporting materials: __________

12. Acknowledgement

• 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: __________