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Prospective Client Intake Information Sheet
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How Did You Hear About Us?
*
Choose One
ARAG
FaceBook
Florida Bar
Google
Other
Case Assist Number (Or Member ID Number)
Please Briefly Describe How You Heard About Our Firm
Please Select One (Entry will be verified with the Court system)
Modest Means
Regular Panel
The About Name
Your Information
Name
*
First
Last
Address
Address Line 1
Address Line 2
City
STATE
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
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Indiana
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Maine
Maryland
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Michigan
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New Hampshire
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New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Your Phone Number
*
Your Email
*
CASE TYPES
Which of our services are of interest to you? Select all that apply.
*
Divorce
Supplemental Petition For Modification
Paternity Custody
Child Suport
Modification
Immigration
Other Case Type
Other Parties Name:
First
Last
Case Pending?
*
Yes
No
Minor Children?
Yes
No
How Many Child(ren)
0
1
2
3
4
5
6
7
8
9
10
Immigration Help
Family Petition
Naturalization
Other
Describe Other Case Type
Describe Other Help You Need Regarding Immigration
County & State
*
Has This Practice Ever Represented You Or Any Of Your Family Members? (Includes Ex-Spouses)
*
Please Choose One
Yes
No
Please Provide The Name, The Nature Of The Case, And An Approximate Representation Date
Case Number
Submit
Prospective Client Intake Sheet
Other Parties Name
Other Parties Last Name
How Did You Hear ABout Us?
FLRB
Yes
No
Your First Name
Your Last Name
Address
Address
City
State
Zip Code
Your Phone Number
Your Email Address
Previous Client?
Yes
No
CASE TYPES (Select All That Apply)
Divorce
Paternity Custody
Modification
Supplemental Petition For Modification
Child Support
Other Case Type
Minor Children
Yes
No
How Many Children
Immigration Help
Family Petition
Naturalization
Other
Case Number
Case Pending
Yes
No
Explain Other
Submit
