CLIENT INTAKE FORM

Thank you so much for contacting our law office! Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

Your Social Insurance number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

Social Insurance numbers are most often used to positively identify parties. Most courts require Social Insurance numbers of all parties in a case. Some other examples of how this information may be used include:

initial service
in court orders
in required reports or other documents filed with the Province

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!

CLIENT INFORMATION

Contact information

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Email Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

EMERGENCY CONTACT

EDUCATION

EMPLOYMENT AND MILITARY HISTORY

MEDICAL HISTORY/MENTAL HEALTH HISTORY

INFORMATION ABOUT ARREST

COURT INFORMATION

(Regarding Your Arraignment)

OTHER ARREST INFORMATION

WITNESSES

BOND INFORMATION

PRIOR CRIMINAL RECORD

(INCLUDING JUVENILE RECORD)

Please select "Fill Out Prior Arrest Charge" and fill out the following information. If it's not applicable, please select "Not Applicable"

PROBATION OR PAROLE

COMMENTS MAY BE OF VALUE

THANK YOU

Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We will contact you as soon as possible with any updates.

Please click the SUBMIT button below when you have finished answering all questions.

Todays Date:

CLIENT INFORMATION

Contact information

Pronouns:

Are you known by any other names?

Driver’s Licence #:

Social Insurance #:

Nationality:

Marital Status:

Do you have any children?

EMERGENCY CONTACT

Name:

Relationship:

Phone:

Address:

EDUCATION

Highest Education:

If you answered "Other" to the previous question, please specify:

EMPLOYMENT AND MILITARY HISTORY

Are you currently employed?

Did you serve in the armed forces?

MEDICAL HISTORY/MENTAL HEALTH HISTORY

What medications do you take?

Have you ever received mental health or substance abuse counselling?

Have you had any chronic health problems?

INFORMATION ABOUT ARREST

City and County of Arrest:

Book #:

Summons #:

Date of Arrest:

Date of Alleged Crime:

Location:

Charges:

COURT INFORMATION

Court Name:

Court Date:

Time:

Upcoming Court Date:

Upcoming Court Date:

OTHER ARREST INFORMATION

Arresting Officer’s Name:

Badge Number:

Was anyone else arrested?

Statements Made to Law Enforcement or Other Parties:

Describe The Events Leading Up to the Arrest In Order:

Have you discussed the crime with anyone else?

WITNESSES

List Any Witnesses to The Alleged Crime:

List Any Alibi Witnesses:

BOND INFORMATION

What Is The Amount of the Bond Posted:

List Any Special Bond Conditions:

PRIOR CRIMINAL RECORD

Prior Arrest Charge #1:

Prior Arrest Date #1:

Prior Arrest Charge #2:

Prior Arrest Date #2:

Prior Arrest Charge #3:

Prior Arrest Date #3:

PROBATION OR PAROLE

Are you currently on probation or parole?

COMMENTS MAY BE OF VALUE

Any other information that may be of value to your case?

How did you learn about our office?

THANK YOU