Sample client intake checklist

Client Information#

1. Full Name of Client:
2. Date of Birth:
3. Gender:
4. Contact Information:
   • Mailing Address:
   • Phone Number:
   • Email Address:
   • Preferred Method of Contact:

Case Information#

5. Type of Case:

6. Case Number (if applicable):
7. Date of Incident (if applicable):
8. Jurisdiction (City/County/State):
9. Opposing Party (if known):
10. Referring Attorney (if applicable):
11. How did the client hear about our law firm?

Legal Background#

12. Have you ever hired an attorney before? (If yes, provide details)

13. Have you ever been involved in a lawsuit before? (If yes, provide details)
14. Have you been served with any legal documents related to this matter?
15. Are there any pending or previous criminal charges or convictions against you? (If yes, provide details)
16. Are there any other legal matters, including family law or bankruptcy, that may be relevant to your current case?

Financial Information#

17. Are you seeking legal representation on an hourly or contingency fee basis?

18. Do you have legal insurance coverage? (If yes, provide details)
19. Are you seeking pro bono or reduced fee representation? (If applicable)
20. Will anyone else be responsible for paying your legal fees? (If yes, provide details)

Documentation#

21. Please provide any relevant documents related to your case, such as contracts, agreements, court orders, correspondence, or evidence.

22. Do you have any upcoming court dates or deadlines related to your case?

Conflicts of Interest#

23. Are there any potential conflicts of interest that the law firm should be aware of?

Client goals and expectations#

24. What are your goals and expectations for this legal representation?

25. Are there any specific outcomes you hope to achieve in your case?

Other Information#

26. Do you have any medical conditions or special accommodations that we should be aware of for meetings or court appearances?

27. Is there any other information you believe is important for us to know about your case or your situation?

Client Signature#

I acknowledge that the information provided in this client intake checklist is accurate to the best of my knowledge and understand that it will be used for the purpose of legal representation by XYZ Law Firm.

Client’s Signature: _______________________________ Date: _______________

Law Firm Representative: Name of Law Firm Representative: _______________________________

Please note that this checklist is a template and should be customized to meet the specific needs and practice areas of your law firm. Additionally, ensure compliance with local and national laws and regulations governing client intake and data privacy.