Client Intake Form

NEW CLIENT INFORMATION

File No.: _______________ Date Opened: _______________

CLIENT:

HOME ADDRESS:

BUSINESS ADDRESS:

HOME PHONE:

BUSINESS PHONE:

REFERRED BY:

FILE NAME:

NATURE OF CASE:

STATUTE OF LIMIT.:

FEE:$PER HOUR

RETAINER

CONTINGENCY

LATE PAYMENT: Yes or No (please circle)

OPPOSING PARTY:

OPPOSING ATTY: