Criminal Law Intake Form
Date form completed
Who can we thank for referring you to us
First Name
Last Name
Email
Phone
Are you calling for yourself or someone else
Self
Someone else
If someone else, who
If for someone else, is person in jail
Yes
No
If yes, what city or parish
Date of Arrest
Place of arrest or charge
Date of Birth of Defendant
What are the charges
Date of next court hearing
Any other details the attorney should know
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