Client Intake

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Your Personal Name

Is our Client an Entity? Is our Client an Entity? Yes No

Entity Name

Address (Line One)

Address (Line Two) (Optional)

City, State, and Zip Code

Phone Number

Additional Phone Number (Optional)

Email Address

Adverse Parties? (If Applicable)

Related parties? (If Applicable)

Were you referred to us? Were you referred to us? Yes No

If referred, by who?

Give a very brief non confidential description of the type of service inquiry you are making.