Criminal Defense Intake Form

Personal Information

CONFIDENTIALITY ATTORNEY-CLIENT COMMUNICATION
This form is protected by attorney-client privilege. We do not discuss your case with anyone else, including on social media. Anything you share with us is confidential

First Name

Last Name

Birthdate (MM/DD/YYYY)

Social Security No. (last 4 digits only)

Current US Address

If in custody, provide both current facility and permanent address

City

State

Zip

Case Information

Type of charges

Date of arrest/citation

Location or arrest/citation

Arresting agency

Case/citation number (if known)

Court information (if known)

Next court date (if scheduled)

Current Case Details
Note: This form is protected by attorney-client privilege. We do not discuss your case with anyone else, including on social media. Anything you share with us is confidential

Brief description of incident

Were you read your Miranda rights?

Did you make any statements to law enforcement?

If yes, please provide details during your consultation

Were there witnesses?

Current status

Current Case Details

If yes, please provide details

Are you currently on probation?

Additional Information

Employement status

Immigration Status (important for understanding potential immigration consequences

Do you have any medical or mental health conditions we should be aware of?

Document Checklist
Please bring the following documents to your consultation if available.

Document checklist

Attorney-Client Notice: All communications between you and our law firm are confidential and protected by attorney-client privilege.

Legal Representation: Completion of this intake form does not establish an attorney-client relationship. We will discuss representation during your consultation.

Accuracy Statement: I certify that the information provided in this form is true and accurate to the best of my knowledge.

Criminal Defense Intake Form

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