client intake form for website

Prospective Client Information Intake Form

Instructions for Use

• Complete all sections below accurately to ensure our team has the necessary information to conduct a conflict check and preliminary assessment.
• Submit this form via secure portal or encrypted email; do not include sensitive financial account numbers or passwords in this document.
• Retain a copy for your records; once submitted, a representative will contact you to confirm the status of your inquiry.

Parties & Definitions

This form is submitted by [Full Legal Name] (the "Prospective Client") to [Law Firm/Company Name] (the "Firm").

Prospective Client Contact Details:

• Full Legal Name: [__________]
• Company/Entity Name (if applicable): [__________]
• Primary Phone: [__________]
• Email Address: [__________]
• Mailing Address: [__________]

Operative Terms

1. No Attorney-Client Relationship: The submission of this form and the receipt of this information by the Firm does not create an attorney-client relationship. Such a relationship is only formed upon the execution of a formal written engagement letter signed by both parties.
2. Confidentiality: While the Firm treats incoming inquiries with professional discretion, no information submitted through this form will be considered confidential or privileged until the Firm has formally accepted the representation.
3. Conflict of Interest: The Firm must perform a conflict check before providing any legal advice. By submitting this form, you acknowledge that the Firm may represent existing or future clients with interests adverse to yours, provided those matters are unrelated to the information disclosed herein.
4. Accuracy of Information: You represent that all information provided in this document is true, accurate, and complete to the best of your knowledge.
5. Matter Description: Please provide a brief summary of the legal matter for which you are seeking representation: [] []
6. Opposing Parties: List all individuals or entities that may be involved as opposing parties in this matter (required for conflict screening): [__________]

Signature & Acknowledgment

By signing below, I acknowledge that I have read the terms above and understand that this submission does not constitute legal representation.

Signature: __________ Printed Name: [] Title: [] Date: [__________]

Legal Disclaimer: This document serves as a general framework for prospective client inquiries. It does not constitute legal advice. Laws regarding attorney-client privilege and electronic communication vary by jurisdiction; consult with qualified counsel to ensure compliance with local bar association requirements.