Thank you for contacting our law office. Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 128-bit SSL encryption.

Social Security numbers and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

Social Security numbers are most often used to positively identify parties. Most courts require Social Security numbers of all parties in a case. Some other examples of how this information may be used include:

initial service
in court orders or forms
in required reports or other documents filed with the State

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you.

Contact information: Proposed Client (You)

Prefix

First name *

Middle name

Last name *

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

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Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

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Phone numbers

Phone number

Type

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Contact information: Decedent's Information

Prefix

First name *

Middle name

Last name *

Date of birth

Emails

Address *

Type

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

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THANK YOU

Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We will contact you as soon as possible with any updates.

Please click the SUBMIT button below when you have finished answering all questions.

Contact information: Proposed Client (You)

Contact information: Decedent's Information

Date of Death

Please upload a copy of the Decedent's death certificate.

Gender

Social Security Number

Please upload a copy of the Decedent's social security card, if available.

Please upload a copy of the Decedent's driver's license, passport or other valid photo ID.

Did the Decedent have a Last Will & Testament?

Marital Status

Did the Decedent have any children (natural or adopted, living or predeceased)?

How were you referred to our law firm?

If our law firm ends up representing you in this matter, will you be the person who pays the legal fees?

ACKNOWLEDGEMENT AND ACCEPTANCE

THANK YOU