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Client Intake Form - Akula & Associates
If the consultation is about someone else, please provide their information. Please be advised that your appointment is for consultation purposes only. If you would like to retain our services, you would need to open a contract for representation with our office after your consultation.
Intending Immigrant’s Name: *
E-mail: *
Address: *
Cell Phone: *
Date of Birth: *
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Place of Birth: *
What language(s) do you speak? *
Do you have Immigration Status/ Papers? *
Date Status Obtained:
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What Status?
When was the last time you entered the U.S.? *
Did you enter the U.S. with a visa: *
Have you, your spouse, children or parents ever been a victim of a crime in the U.S.? If yes, what type of crime and date it happened: *
Do you have any relatives (children, spouse, parent, or sibling) who are U.S. citizens or Legal Permanent Residents? *
Have you ever been arrested for ANY crime? *
If Yes, what was the date?
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If Yes, what was the charge?
What is the immigration issue you wish to discuss with the attorney today? *
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