Full Name:

[Your Name]

Date of Birth:

[June 12, 2050]

Contact Number:

[444-2222]

Email Address:

[Your Email]

1. Briefly describe the legal issue you need assistance with:

                                                                                                                           

                                                                                                                           

2. What is the current status of your legal issue?

                                                                                                                           

                                                                                                                           

3. What are your expectations from this legal service?

                                                                                                                           

                                                                                                                           

4. Have you previously hired any legal representation for this issue?

   • Yes

   • No

   If yes, please provide details:                                                                             

5. What is your current employment status?

6. What is your yearly income range?

7. Do you have any budget constraints for handling the legal matter?

   • Yes

   • No

   If yes, please specify your budget. ________________

8. Have you previously hired any legal representation for this issue?

   • Yes

   • No

   If yes, please provide information                                                                     

9. Have you ever been involved in any legal cases in the past?

   • Yes

   • No

   If yes, please provide a brief overview.

10. What was the outcome of those cases?

11. Is there any other information you believe would be helpful to our representation on your behalf?

    • Yes

    • No

    If yes, please provide information.

                                                                                                                            

                                                                                                                            

Gender:                               

Origin/Ethnicity: