From the 'Lectric Law Library
Initial Client Interview Form

Today's Date:______________

INITIAL CLIENT VISIT

Please fill out as much as you can.  Everything you write is confidential
and protected by the attorney-client privilege.

Name:

Address:


Home telephone:                    Work Telephone:

Employer:

Birthdate:                  Social Security Number:

Married    Divorced    Single    Widowed   (circle one)

Children: (name, sex, age)


How did you learn about this attorney? (Yellow pages, referral, etc)


SUBJECT MATTER (CIRCLE ONE)

BANKRUPTCY     CRIMINAL     DIVORCE/FAMILY LAW     BUSINESS

PERSONAL INJURY   IMMIGRATION   EMPLOYMENT/WORK COMP

OTHER INFORMATION:
HAVE YOU SEEN ANOTHER ATTORNEY?  IF SO, WHO?


HAVE YOU SEEN A DOCTOR?  IF SO, WHO?


BRIEFLY DESCRIBE THE FACTS OF YOUR SITUATION OR CASE:




NAMES OF WITNESSES:


WHAT FINAL RESULT ARE YOU LOOKING FOR?

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[Last Revised 3/02]