Defense Intake Form

Please fill out the appropriate information for this form. The use of this form for communication with the firm or its representatives does not establish attorney-client relationship. Confidential or time-sensitive information should not be sent by using this form. It is not a secure method of communication.

Fields marked with an * are required.

Full Name*:
Address:
City:
State:
Phone:
FAX:
Email*:
Booking #:
Court Room:
Time:
Court Name:
Division/Room:
Arresting Office Name and Badge::
City of Arrest:
Was the crime a:
Have you been convicted of a similar crime before?
Yes
No

If Yes, when?:
Have you been convicted of other offenses?
Yes
No

If Yes, when and what?:
Are you on probation or parole?
Yes
No
If Yes, for what?:
Do you have other cases pending?
Yes
No

Was anyone else arrested?
Yes
No

If yes, name(s) of all persons arrested:
What statements did you make to the police concerning the alledged crime?
Describe the order of events leading up to the arrest:
Have you discussed this alledged crime with anyone else?
Yes
No

If so, who did you discuss it with and what did you tell them?
Were there any witnesses to the alledged crime?
Yes
No

If yes, please provide names and contact information (if known)?
Amount of bond posted:
Are there any special bond conditions?
Yes
No

Were you referred to us by someone else?
Yes
No

If yes, who?
The use of this form for communication with the firm or its representatives does not establish attorney-client relationship. Confidential or time-sensitive information should not be sent by using this form. It is not a secure method of communication.

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