Client Intake Form
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Type of Case *
Court *
Name *
First and last name
Email *
Phone Number *
Mailing Address *
Do you consent to receive legal information via email?
*
Do you a have a professional license?  *
If yes, please explain
i.e. - CDL, Teaching, Engineering
Present Employer *
Military Experience
Clear selection
If yes, please explain
Medical information
Please list any medications you are currently taking or
any medical history you think would be pertinent to your case/situation.
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