Dawn Florio Law Client Intake
This form will help us determine how we can best assist you. Please add as much information as you can and someone will be with you shortly.
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Phone Number *
Have you been arrested? *
Are you wanted by the police? *
Are you looking to have an attorney on retainer? *
Have you been indicted? *
Indicted for what? *
State or federal case?
Which state did the incident occur in? *
Which county did the incident occur in?
Date of incident
MM
/
DD
/
YYYY
When is your next court date?
MM
/
DD
/
YYYY
What is the best time to contact you?
Anything else we should know? Do you have any questions?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Dawn M. Florio Law Firm PLLC. Report Abuse