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Thank you for choosing our law firm to assist you with your financial needs. Please fill out this form with as much detail as possible. All information you provide will be kept in the strictest confidence. When you have finished filling out this form, return to us for the attorney to review. We look forward to helping you achieve your financial goals and get a fresh start to a better financial future.

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  • INITIAL INTAKE FORM

    Please answer the following "yes" and "no" questions. All information will be kept in the strictest confidence.
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    Year

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    Months

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    Vehicles
    Vehicles

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    Months

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    YOUR INCOME

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  • MONTHLY LIVING EXPENSES

    Please provide an AVERAGE amount that your household pays PER MONTH for the following expenses:
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    STATEMENT OF ACCURACY

  • CHECK BOX IMPORTANT: CHECK BOX IF YOU AGREE TO THE FOLLOWING STATEMENT 

    By checking this box you state the information on this Initial Intake Form is true and correct to the best of my/our knowledge. I/We understand that providing inaccurate information can detrimentally affect my/our case, cause an undue outcome or result in charges brought against me/us if convicted of fraud. I/We also understand the information provided in this Initial Intake Form will not be shared with any other party, other than attorneys who have the knowledge to legally advise me/us and authorized parties assigned by the attorneys to work on my/our case.