Section 19 Client Interview Form

• Library: Civil Trial Practice 2008 Supp Forms

Client Interview Form

A. GENERAL INFORMATION

Client(s) ______________________________________________________________________
Age ______________________ Social Security # ____________________________________
Address ______________________________________________________________________
______________________________________________________________________________
Phone: Residential ________________ Business ________________ Cell _________________
E-Mail Address_________________________________________________________________
Permanent Address _____________________________________________________________
______________________________________________________________________________
Parents' Address _______________________________________________________________
______________________________________________________________________________
Spouse _______________________________________________________________________
Place of employment ____________________________________ Number of years _________
Wages _______________________________________________________________________
Dates and places of residence for past ten years _______________________________________
______________________________________________________________________________
Other names used by client _______________________________________________________
Where and when born ___________________________________________________________
Marital history _________________________________________________________________
Names, addresses, ages, and relationship of all dependents ______________________________
______________________________________________________________________________
Employment history (first, job title, wage rate, reason for leaving)
______________________________________________________________________________
Educational history _____________________________________________________________
______________________________________________________________________________
Military history (dates, branch, rank, serial number, type of discharge)______________________
______________________________________________________________________________
Criminal record (include traffic offenses) ____________________________________________
______________________________________________________________________________
Driving record (prior accidents, license suspensions, etc.) _______________________________
______________________________________________________________________________

B. FACTS OF ACCIDENT

Name and address of all potential defendants (indicate if principal, agent, corporation, partnership)
______________________________________________________________________________
______________________________________________________________________________
Date of...