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Intake Form

General Intake Form

*Name:

*Address:

*City:

*State:

*Zip:

*E-mail address:

*Home Phone:

Business Phone:

Cellular or Pager:

Facsimile:

Are you known by any other names?
Yes  No 

If yes, list other names you have used:

What is your marital status?

Does this matter involve a business you own or run?
Yes  No 

If yes, provide the business name, address, and phone:

If a business is involved, how is the business organized (if known)?

Are you employed?
Yes  No 

If yes, please provide your job title and employer's name and address.

Can you be contacted at work?
Yes  No 

What area of law does your situation involve (if known)?

Describe your situation, including any relevant dates:

How would you rate your legal needs described here?

Are any other people involved?
Yes  No 

If yes, provide names, addresses (if known), and their relationship to you, if any:

Do you have any documents that could help explain your situation?
Yes  No 

If yes, list those documents and their dates:

Are there other documents that you do not have access to that could be of assistance?
Yes  No 

If yes, list those documents and their dates and locations (if known):

Describe how this situation has impacted you:

Describe what you would like to happen to resolve your issue (your preferred outcome):

Have other attorneys worked on this matter?
Yes  No 

If yes, provide names, addresses, and a brief description of their involvement:

Special concerns:

Where did you hear about this website? [pulldown, including the following options

 

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Abrams & Abrams, P.A., handles catastrophic personal injury cases for people throughout North Carolina, South Carolina, and Virginia, including the cites of Greensboro, Durham, Charlotte, Fayetteville, Jacksonville, Morganton, and Raleigh in North Carolina (NC); Richmond, and Virginia Beach in Virginia (VA); and Columbia, Charleston, Greenville, Spartanburg, and Rock Hill in South Carolina (SC).