JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Criminal Defense Client Intake Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Client Name
*
Your answer
Today's Date
*
MM
/
DD
/
YYYY
Potential client's date of birth:
*
MM
/
DD
/
YYYY
Contact Number
*
Your answer
Emergency Contact (Name and number)
*
Your answer
Email Address
*
Your answer
Referred by
Your answer
If your case is in branch court, are you able to pay a MINIMUM deposit of $2,500 towards your legal fees up front?
*
Your answer
If your case has already had a preliminary hearing or been indicted, are you able to pay a MINIMUM deposit of $4,000 towards your legal fees up front?*
*Required deposit payments can differ depending on charges, location, and background.
*
Your answer
How much can you afford for your case in total?
*
Your answer
Preferred Payment Method:
*
Credit/debit card
Cash
Zelle
Cash App
Case number and charges
*
Your answer
Does potential client have a private attorney? If so, what is their name?
*
Your answer
Next Court Date
*
Your answer
Courthouse Location
Your answer
Was anyone else arrested?
*
Yes
No
N/A
If so, name(s) of person(s) arrested:
Your answer
Potential client is currently:
*
Out on bond
In custody
Other:
Special Conditions:
*
Electronic Monitoring
Pre-trial Services
None
Other:
Is potential client currently on probation or parole?
*
Yes
No
If so, for what offense?
Your answer
Please provide facts/details regarding potential case
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of C. Norris Law Group, LLC.
Report Abuse
Forms
