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Prospective Client Engagement Intake Form

Instructions for Use

• Complete all fields marked with brackets [ ] by typing or handwriting the required information clearly.
• Review the operative clauses carefully to ensure they align with your firm’s specific practice area and standard workflow.
• Once completed, sign and date the document, then return a copy to the firm via secure portal or physical mail to initiate the conflict check process.

Parties & Definitions

This Intake Form is submitted by [Full Legal Name] ("Prospective Client") to [Law Firm Name] ("Firm") regarding the potential representation in the matter of [Brief Description of Legal Matter] ("Matter").

Operative Clauses

1. Purpose of Intake. The Prospective Client acknowledges that the submission of this form is for the sole purpose of enabling the Firm to conduct a conflict-of-interest check.
2. No Attorney-Client Relationship. Completion and submission of this form do not create an attorney-client relationship. Such a relationship is formed only upon the mutual execution of a formal Engagement Agreement.
3. Confidentiality. Information provided herein will be treated as confidential; however, the Firm reserves the right to represent adverse parties in matters unrelated to the subject matter described above unless otherwise prohibited by law.
4. Conflict Check. The Prospective Client represents that the following parties are involved in this Matter: [List Opposing Parties/Related Entities].
5. Document Retention. The Firm will maintain this information in accordance with its document retention policy. If no engagement occurs, this information will be securely destroyed or archived as required by local professional conduct rules.
6. Communication Preference. The Firm may contact the Prospective Client via:
   • Email: [Email Address]
   • Phone: [Phone Number]
   • Secure Portal: [Portal URL]

Signature & Acknowledgment

By signing below, I certify that the information provided is true and accurate to the best of my knowledge and that I understand the terms regarding the initiation of legal representation.

Signature: __________ Printed Name: [Full Legal Name] Title: [Individual / Authorized Representative] Date: [Date]

Legal Disclaimer: This document is a general framework and does not constitute legal advice. You must consult with qualified counsel in your jurisdiction to ensure this form complies with local bar association rules, professional conduct standards, and data privacy regulations.