MobileClientIntake

Client Intake Form

Please complete the following form to request a consultation with McCroskey Law Firm. All fields are required unless otherwise indicated.

Prefix

First Name

Middle Name

Last Name

Date of Birth

Street Address 1

Street Address 2 (optional)

City

State

Zip Code

Primary Phone Number

May we send text notifications to your primary phone number?

Yes No

Primary E-mail Address

May we send notifications to your primary e-mail address?

Yes No

Type of legal matter you have

Please give us a brief description of your legal matter. If other people are involved (witnesses, co-defendants, victims, etc.), please provide those names if known.

Examples:
"I was charged with speeding 50 mph in a 35 mph zone in Archdale."
"I was charged with stealing a lawnmower from my neighbor, Sam Smith."
"I need a simple will, power of attorney, and health care power of attorney before I go on my vacation next month."

Description

So that we can better serve our clients' needs, please tell us how you heard about our law firm.

How you heard about us

Other referral source