Legal Case Intake Form

Thank you for choosing our legal services. Please complete this form with as much detail as possible and check the appropriate boxes in order to facilitate a thorough assessment of your situation. If a section is not applicable, kindly mark it as N/A. Please also ensure to provide copies of relevant documents to assist us in better understanding and addressing your case. Your cooperation in providing accurate information is crucial.

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Personal Information

Client Information

Full Name:
Date of Birth:
Social Security Number:
Address:

Contact Information

Phone Number:
Email Address:
Preferred Method of Contact:	Email Phone

Legal Services Needed

Select the specific legal services you require:

• Consultation

• Contract Review

• Legal Representation

• Document Preparation

• Mediation

• Other (please specify):

Case Details

Case Overview

I am seeking legal representation for a business contract dispute. The opposing party has breached the terms, leading to financial losses for my business.

Incident Information

Items	Details
Date of Incident:	[Month Day, Year]
Time of Incident:	[HH:MM AM/PM]

Legal Issues

Breach of contract, financial losses, and potential damage to my business reputation.

Opposing Party

Items	Details
Name of Opposing Party:
Opposing Party's Attorney (if known):

Employment Details (if applicable)

Current Employer/Source of Income:
Position/Type of Work:
Employment Start Date/Commencement Date:	[Month Day, Year]
Description of Employment Issue (if applicable):

Supporting Documents

• Contracts

• Correspondence

• Court Notices

• Agreements

• Financial Statements

• Photos/Visual Evidence

• Medical Records

• Other (please specify):

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Thank you for taking the time to complete this form. If you have any questions or need clarification, please do not hesitate to contact us at [Your Company Number] or email at [Your Company Email].

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