FLORIDA BAR REFERRAL INITIAL CLIENT CONSULTATION INTERVIEW FORM
The purpose of an initial consultation is for the attorney to advise you, the prospective client what, if anything, may be
done for you, and what the fee therefore will be. The purpose is not to render a definitive legal opinion as it may be
impossible to fully assess a matter within the time frame allotted for a consultation or with the (information or documents) that you may be able to provide at the initial consultation.

One of three outcomes is possible following your consultation:

1. You and the Attorney mutually agree to the terms of representation,
(After a separate document called Representation Agreement is signed, a copy will be provided to you.)

2. The Attorney declines representation, or

3. You decide not to use the services of the Attorney.

Note: The following questions will help us to understand the reason for your visit today. Your responses are protected by
attorney/client privilege and will be held in strict confidence.

Email address *
Name (First, Middle, Last) *
Your answer
Address ( Address, City, State, Zip Code) *
Your answer
Phone (Home, Cell, Work) *
Your answer
Are there other parties involved? (Examples: friends, employers, neighbors, business associates, corporations, limitedliability companies, businesses, etc.).
People or Parties - Relationship *
You should include people or parties on either side of your issue.
Your answer
Briefly explain what you may need advice about or assistance with: *
Your answer
On the lines below, please list any documents (papers) that you think may help us understand the issues.
Your answer
PLEASE READ CAREFULLY
Following your initial interview, if you agree to hire the Attorney, and the Attorney agrees to represent you, you will both
sign an Agreement for Representation. The Agreement for Representation will set forth the terms and conditions of
representation.

NOTICE: This office does not represent you with regard to the matters set forth by you herein in this information
sheet or discussed during your consultation, unless and until, both you and the Attorney execute a written
Agreement for Representation.

If the Attorney does not agree to represent you, and your legal problem(s) involve a potential lawsuit, it is important that
you realize a lawsuit must be filed within a certain period of time called a Statute of Limitations. Therefore, the Attorney
strongly urges you to immediately consult with another attorney to protect your rights. The Attorney’s decision not to
represent you should not be taken by you as an expression regarding the merits of your case.

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