***Complete the Intake Form below and select the “Submit Form” button. Once you have done this, you can schedule an appointment in the calendar on the right.

***Because I am working for and at the direction of an attorney, the details you provide me within this call are protected by attorney-client privilege and that means they won’t be shared with anyone outside of our law firm.

Basic Information:

Caller First Name *

Caller Last Name *

Phone Number *

Permission to text *

Yes

No

Email Address

Relationship to Potential Client (if applicable)

Preferred Language *

Preferred Method of Contact

Potential Client First Name

Potential Client Last Name

Potential Client Phone Number

Consent to receive text messages

Yes

No

Potential Client Email Address

Potential Client Preferred Language

Potential Client Preferred Method of Contact

Name As It Appears On Documentation from Law Enforcement or Previous Cases *

Potential Client Date of Birth

How did you hear about us? *

If referral, add the name below

Incident/Case Details:

Case Type *

Please specify your case type for Serious Allegations

Please specify your case type for Misdemeanor

Please specify your case type

How many prior DUI’s have you had?

Has an APS hearing been scheduled?

Date of Hearing

Location of Incident

San Luis Obispo County

Santa Barbara County

Alleged Incident Date(s) Details

Arrest Date

Were you taken to the county jail or held at a police department?

Yes

No

How long were you held?

Court Date

***The following questions are being asked so that I can prepare the most comprehensive information for your call with the attorney and so the attorney can give you the most value during that call. Because I am employed by this law firm and am working for these attorneys, our conversation is covered by attorney-client privilege and is confidential within this firm.

Other Factors:

Are you concerned that a pending case could impact your current employment?

Yes

No

What type of work do you do?

Do you hold a professional license through the state of CA or Federal Government?

Yes

No

What type of license do you hold?

***A professional license is a certification or license where you must complete annual reporting through the State of California or Federal Government.

Are you a United States citizen?

Yes

No

Do you have legal status in the United States?

Yes

No

What is your immigration status?

Are you involved with any immigration process currently?

Including an immigration attorney or immigration court?

If you have an attorney, what is their name and contact information?

*** Check CA Bar for Full Attorney Information

Do you have any convictions on your record?

Yes

No

Have you served probation, jail time, prison time, or parole on a case?

Yes

No

Has it been completed successfully?

Yes

No

Were there any violations?

Yes

No

***Portal Information: Search and upload and information in either the San Luis Obispo or Santa Barabara attorney portals.

SLO Portal Checked

SB Portal Checked

San Luis Obispo Portal Checked

Santa Barabara Portal Checked

Booking Log

Who’s In Custody – SLO

Who’s In Custody – SB

SLO

SB

Notes

Intake Stages *

Referred Out Name:

Referred Out Email:

Referred Out Phone:

Reason for DNQ

Reason for Not Retained

Intake Specialist *

Consult Set With

*** To submit the intake form, all fields must be completely filled out with accurate information.