Client

Intake Form

1. Client Information

Salutation

First Name

Middle Name

Last Name

Email

Phone Number (Required for Text Contact)

1A. Preferred Contact Method(s)

Please check all preferred methods for us to contact you:

Text Mail Email

1B. Authorized Contact (Optional)

List one person (e.g., spouse, family member) we may speak with regarding your case:

Authorized Contact Name

Authorized Contact Phone

2. Address

Street Address

City

State

Zip Code

3. Driver's License and Date of Birth (Optional)

Date of Birth

Driver's License #

License State

4. Case Details

Court Date (if known)

County Where Charged

Court Room (if known)

File Number (if known)

5. Charges

Charge 1

Charge 2

Charge 3

828-333-4867

828-333-4867

Client

Intake Form

1. Client Information

1A. Preferred Contact Method(s)

Please check all preferred methods for us to contact you:

1B. Authorized Contact (Optional)

List one person (e.g., spouse, family member) we may speak with regarding your case:

2. Address

3. Driver's License and Date of Birth (Optional)

4. Case Details

5. Charges

This form is for submitting information to Dillin Law PC and does not in and of itself create an attorney-client relationship

Contact Information

Our Services

Thank you — your intake form has been successfully submitted.

Our team is reviewing your information and will reach out soon to discuss your legal matter and next steps.

¡Hablamos Español, Llámame hoy 828-333-4867 o empieza aqui!