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Dawn Florio Law Client Intake
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Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
*
Your answer
Have you been arrested?
*
Choose
YES
No
Are you wanted by the police?
*
Choose
YES
No
Are you looking to have an attorney on retainer?
*
Choose
YES
No
Have you been indicted?
*
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YES
No
Indicted for what?
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Choose
YES
No
State or federal case?
Your answer
Which state did the incident occur in?
*
Your answer
Which county did the incident occur in?
Your answer
Date of incident
MM
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DD
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YYYY
When is your next court date?
MM
/
DD
/
YYYY
What is the best time to contact you?
Your answer
Anything else we should know? Do you have any questions?
Your answer
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