Client Intake Form
Dear Prospective / New Client:

This intake form allows us to gather initial information, conduct a basic screening and obtain sufficient details to run a conflict check through our system. When you are ready to proceed, please click the box below and continue until you reach the thank you screen.

Please be advised that completing this form does not mean that you have retained the services of Kutty & Associates. We can only represent you once you have signed a retainer agreement with us and paid our initial retainer fee.

Once you complete this form, one of our staff will contact you to schedule a consultation with one of our lawyers. Following your consultation, you may decide to retain the offices of Kutty & Associates.

INFORMATION ABOUT YOU
Contact Information
Salutation
First Name *
Middle Name
Last Name *
Company
Email Address *
ADDRESS
Street Address *
City *
Province / State *
Postal Code / Zip *
PHONE NUMBERS
Primary: *
Secondary
Other Names you have used:
Gender *
Is it OK to leave a voicemail on the phone numbers you have provided? *
Please provide your Identification Number: (driver's license, passport, citizenship or PR card) - We may require you to email us a clear picture of the ID at a later time. *
Occupation (Employer & Title) *
How were you referred to our Firm *
Please provide information for your emergency contact (Name & Number):
Name of your current spouse: (if you do not have one, enter N/A) *
MATTER DETAILS *
Required
Upcoming court dates and issues set for those dates (if applicable):
Please use this space to provide additional information about the assistance that you are seeking:
INFORMATION ABOUT THE OTHER PARTY
(We require this information by Law in order to complete a conflict check)
Full Name of the Other Party: (if not applicable, enter N/A) *
I understand that by completing and providing the information as contained in this intake form I am only doing so for the purpose of obtaining a consultation with Kutty & Associates: *
The consultation requires the payment of a consultation fee. This fee must be paid in advance of the consultation. This fee is for the consultation only and is not a retainer for future services. Please select one of the following options for a consultation: (NOTE: We offer FREE consultations for Personal Injury matters) *
Required
What day(s) would be best for you to schedule a consultation, between the hours of 9am EST and 5pm EST, would be: *
What method would you prefer to utilize to conduct the consultation: *
Until we are formally retained we do not represent you in your matter. Following your consultation, should you choose to retain Kutty & Associates, a specific appointment for that purpose will be set. Until you decide to retain Kutty & Associates, and we agree to take your case, the retainer agreement has been signed and the retainer fee has been paid, we do not represent you in your matter. *
I consent to receiving e-mail communication from Kutty & Associates *
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