Intake Form

Dear Potential Client:

First, allow me to thank you for the opportunity to serve you in this matter.  Second, the issues discussed in your initial consultation are protected by the attorney-client privilege whether you hire me or not.  Therefore, it is very important that you are completely candid during our discussion.  Your candor is required to properly advise you in this matter.  Thank you for your cooperation.

The purpose of the initial consultation is to advise the you what if anything, may be done for you.  The purpose is not to render a definitive legal opinion as it may be impossible to fully access the matter within the time frame allotted for a consultation or with the information you may be able to provide at the initial consultation.

CLIENT INFORMATION

Name: *
Address 1: *
Address 2:
City: *
State: *
ZIP: *
Date of Birth: *
Employer:
Occupation:
Email:
Phone: *
Home Work Cell
Briefly explain what you need advice about or assistance with today: *
Who are the parties involved? (Examples: a spouse, a friend, an employer, a company or corporation, etc. This should include parties on either side of your issue.)
Please clarify your urgency in concluding this matter:
Critical - Personal safety or continuation of business depends on it.
Very Important - Severe hardship, personal or financial inconvenience if not resolved quickly.
Important - Matter interferes with business or personal financial stability.
Moderate - Needs to be done, but no immediate hardship in the interim.
Low - Just thought Id see if it was worth pursuing.
Curious - I just want to know what my rights are.
Are we the first attorneys you have contacted in this matter?:
Yes
No
If no to the above answer, why did not retain their services?
Are you known by any other names?:
Yes
No
If yes to the above answer, please list other names or aliases:
 
If your mail is returned as undeliverable or telephone services are terminated, please provide the name of two people (friend or relative) you believe will always know how to contact you:
Relative 1:
Address/City/ZIP:
Phone:
 
Relative 2:
Address/City/ZIP:
Phone:
How did you learn about our office?

PLEASE READ CAREFULLY BEFORE SUBMITTING:

Following your initial interview, if you agree to hire the Attorney, and the Attorney agrees to represent you, you will both sign an Agreement for Representation. The Agreement for Representation will set forth the terms and conditions of your representation.

If the attorney is willing to represent you and you decide not to sign an Agreement of Representation today, you are strongly urged to schedule a second appointment with the Attorney at the earliest possible time or to immediately consult with other legal counsel to protect your rights.

NOTICE: The Attorney does not represent you with regard to the matters set forth by you herein in this information sheet or discussed during your consultation unless or until, both you and the Attorney execute a written Agreement for Representation.

If the Attorney does not agree to represent you, this includes not representing you with regard to the matter set forth by you on this information sheet, nor any other matters you may discuss with the Attorney during your consultation. If your legal problem(s) involve a potential lawsuit, it is important that you realize a lawsuit must be filed within a certain period of time called a Statute of Limitations. Therefore, the Attorney strongly urges you to immediately consult with another attorney to protect your rights. The Attorney’s decision not to represent you should not be taken by you as an expression regarding the merits of your case.

  By checking this box and submitting this form, you acknowledge that you are the individual mentioned above and this does not mean you have hired the Attorney.
 
Oklahoma Juvenile Lawyer
Rick J. Henthorn, PLLC
Attorney and Counselor at Law
P.O. Box 850559
Yukon, OK 73085
405-354-6800 (ofc)
405-265-3275 (fax)
info@henthornlaw.net

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