Criminal Legal Intake

Confidential Intake Form
Secure & ConfidentialAttorney-Client PrivilegeTake 10–15 minutes
Step 1 of 6Caller Contact
17%

Caller Contact

Choose the caller’s role first. If someone is calling for the client, the represented client’s information is collected separately.

Caller Type*
Select the role that accurately describes the person currently speaking with intake.

Primary Contact Information

Both mobile number and email address are required for retainer delivery, PracticePanther contact creation, and automated email/SMS notifications.

Enter the first name of the person currently speaking with the intake team.

Enter the last name of the person currently speaking with the intake team.

Required for SMS alerts and time-sensitive intake notifications.

Required for retainer delivery, email alerts, and PracticePanther contact creation.

Enter the client’s date of birth using MM-DD-YYYY when the caller is the client.

Select the represented client’s current marital status.

Enter the represented client’s number of children, including 0 when applicable.

Confirm whether the represented client is currently employed.

Enter the represented client’s current occupation or job title, if applicable.

Language & Agreement Details

Confirm communication language and the agreement sequence used by the existing retainer workflow.

Select the language the caller prefers for communication.

Select whether this is the first, second, or third retainer agreement for this client.