Immigration Case Intake Form

Personal Information

First Name

Last Name

Date of Birth

Country of Birth

Citizenship

Current US Address

City

State

Zip

Phone Number

Immigration Status

Current Immigration Status

If Visa Holder, Current Visa Type

Date of last Entry to U.S.

1-94 Number (if applicable)

Have you ever been in immigration court proceedings?

Type of immigration Assistance Needed

Primary Service Needed

Brief description of your immigration matter

Family Information

Marital Status

Do you have children?

Do you have immediate family members who are U.S. citizens?

Additional Information

Have you ever been arrested or convicted of a crime?

Have you ever been denied a visa ir immigration benefit?

Have you ever filed any applications with USCIS?

If yes, please bring copies of all applications and decisions

Document Checklist

Please bring the following documents to your consultation (if applicable) Passport

PRIVACY NOTICE: The information provided in this form is protected by attorney-client privilege and will be used solely for the purpose of evaluating your immigration case.

ACCURACY STATEMENT: I certify that the information provided is true and correct to the best of my knowledge. I understand that providing false information may result in denial of my immigration case and possible criminal penalties.

CONSULTATION FEE NOTICES: Please note that there may be a consultation fee, which will be discussed when shceduling your appointment. This fee may be applied to future legal services if you retain our firm.

Immigration Case Intake Form

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