General Intake Form

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Thank you for your interest in the Law Offices of Andrew J. Sosnowski. This form is used to collect information about potential new clients and is used for internal purposes only. The information you provide is confidential and will be treated accordingly.

Submitting this form does not create an attorney-client relationship and the information provided does not constitute legal advice nor does it constitute an attorney client agreement.

Prefix

First Name

Middle Name

Last Name

Suffix

Cell Phone Number

Home Phone Number

Work Phone Number

Other Phone Number

Address

Apartment/Suite

City

State

Zip

How would you prefer to have correspondences with this office?

How would you prefer to receive your invoices?

Gender

Date of Birth (YYYY-MM-DD)

Driver’s License or ID No.

Marital Status

Employment Status

Employer

Occupation

Address

City

State

Zip

Emergency Contact Information

Prefix

First Name

Last Name

Your Relationship with Emergency Contact

Cell Phone Number

Home Phone Number

Work Phone Number

Other Phone Number

Address

Same as Yours

Address

Apartment/Suite

City

State

Zip

Spouse Information

Prefix

First Name

Middle Name

Last Name

Suffix

Cell Phone Number

Home Phone Number

Work Phone Number

Other Phone Number

Address

Same as Yours

Address

Apartment/Suite

City

State

Zip

Gender

Date of Birth (YYYY-MM-DD)

Driver’s License or ID No.

Employment Status

Employer

Occupation

Address

City

State

Zip

Legal Issue & Case Information

Brief Summary of Legal Issue:

Type of Case

Case Number (If known)

Referral Information

How did you hear about us?

Name of who referred:

Notice about Attorney-Client Relationship

The purpose of this initial consultation is to determine if the Law Offices of Andrew J. Sosnowski can assist you with your legal needs, to inform you about the services our firm provides, and to discuss the potential agreement for the provision of legal services and formation of an attorney-client relationship. This initial consultation does not create an attorney-client relationship and does not mean the Law Offices of Andrew J. Sosnowski will act as your attorneys. After the initial consultation, if your case/matter is accepted by the Law Offices of Andrew J. Sosnowski and you desire to retain the Law Offices of Andrew J. Sosnowski as your attorneys, we will provide you with a written fee agreement which will set forth the terms of the agreement for legal services. Upon receipt of the signed fee agreement and the required retainer, we will begin to act as your attorneys.

Your legal rights may be affected by laws that place time restrictions on certain legal claims or may be otherwise affected if prompt action is not taken. If the Law Offices of Andrew J. Sosnowski does not accept your case/matter or you decide not to retain our services, you should seek alternate legal counsel immediately to ensure that your legal rights are not affected.

THE LAW OFFICES OF ANDREW J. SOSNOWSKI WILL NOT TAKE ANY ACTION ON YOUR BEHALF PRIOR TO RECEIPT AND ACCEPTANCE BY OUR LAW FIRM OF A SIGNED FEE AGREEMENT AND REQUIRED RETAINER FEE.

IF THE LAW OFFICES OF ANDREW J. SOSNOWSKI CHOOSE TO NOT TAKE YOUR CASE, ALL INFORMATION PROVIDED WILL BE PROTECTED FROM DISCLOSURE.