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Civil Intake FormNEW

The document is a client intake form for an attorney that collects personal information from prospective clients. It explains that the initial consultation is to advise clients on possible actions and fees, but not provide definitive legal opinions. One of four outcomes is possible after the consultation: plain advice, agreement on representation terms, declined representation, or the client decides not to use the attorney's services. The form collects contact and case details, acknowledges that completion does not mean representation, and obtains consent to use personal data in accordance with privacy laws.

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177 views

Civil Intake FormNEW

The document is a client intake form for an attorney that collects personal information from prospective clients. It explains that the initial consultation is to advise clients on possible actions and fees, but not provide definitive legal opinions. One of four outcomes is possible after the consultation: plain advice, agreement on representation terms, declined representation, or the client decides not to use the attorney's services. The form collects contact and case details, acknowledges that completion does not mean representation, and obtains consent to use personal data in accordance with privacy laws.

Uploaded by

harve_abella
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Client Intake Form

The purpose of this form is to gather the information needed by the


Attorney before scheduling an initial consultation. The purpose of an initial
consultation is for the attorney to advise you, the prospective client what if
anything, may be done for you, and what the minimum fee therefor will be.

The purpose is not to render a definitive legal opinion as it may be


impossible to fully assess a matter within the time frame allotted for a
consultation or with the (information or documents) that you may be able
to provide at the initial consultation. One of four (4) outcomes is possible
following your consultation.

A. Plain consultation only or with written advice;


B. You and the Attorney mutually agree to the terms of
representation, or (After a separate document called an
Agreement for Representation is signed a copy will be provided
to you.)
C. The Attorney declines representation, or
D. You decide not to use the services of the Attorney.

Note: The following questions will help us to understand the reason for your
consultation. Your responses are protected by attorney/client privilege and
will be held in strict confidence.

Name
Last: last name
First: first name
Middle: middle name
Are you known by any other name? ☐Yes ☐No

If yes, name(s): alternate name/s


(A fictitious name, a nickname, former name, maiden name, etc.,)

Address
Permanent Address: house number, street number, barangay, city

Contact Information
Primary contact number: +6332-
Primary email address: email address
Client Intake Form

Briefly explain what you may need advice about or assistance:


Summary of inquiry:
WHAT happened?

WHERE did it occur?

WHEN did it happen?

HOW was it done?

Please classify your urgency in concluding this matter. (check one)

☐ Critical – personal safety or continuation of business depends on it;


☐ Very important – severe hardship, personal or financial inconvenience if
matter is not resolved quickly.
☐ Important – matter interferes with business or personal financial
stability;
☐ Needs to be done but no immediate hardship in the interim.
☐ Just thought I’d see if it was worth pursuing;
☐ Just wanted to know what my rights are and then I’ll let you know
after I think about it.
☐ Just considering legal outcomes and impact on my person for decisions
to be made.

If the matter involves the payment of money you feel you are owned, how
long can you wait before not getting paid? Days/weeks/months/years

Are we the first attorneys you have consulted regarding this matter?
☐ Yes ☐ No
If no – why didn’t you hire their services?
Briefly. No need to mention the attorney/s name/s

Have you ever been represented by an attorney before? ☐ Yes ☐ No


If yes, please state the circumstances: briefly

How did you learn of our office?


☐ A friend ☐ Former client
☐ Webpage ☐ Other: expound

PLEASE READ CAREFULLY AND ACKNOWLEDGE BELOW

Following your initial interview, if the outcome of the same is that


you need legal representation, an Agreement for Representation also
known as an Engagement Proposal for Legal Services shall be sent to you
which shall set forth the terms and conditions of representation. If the
Attorney is willing to represent you and you decide not to sign an
Agreement of Representation today, you are strongly urged to schedule a
second appointment with the Attorney at the earliest possible time or to
immediately consult with other legal counsel to protect your rights.

NOTICE: This office does not represent you with regard to the matters you
set forth in this information sheet or discussed during your consultation
unless and until, both you and the Attorney execute a written Agreement
for Representation. If the Attorney does not agree to represent you, this
includes not representing you with regard to the matter set forth by you on
this information sheet, nor any other matters you may discuss with the
Attorney during your consultation. If your legal problem(s) involve a
potential lawsuit, it is important that you realize a lawsuit must be filed
within a certain period of time called a Statute of Limitations. Therefore,
the Attorney strongly urges you to immediately consult with another
attorney to protect your rights. The Attorney’s decision not to represent you
should not be taken by you as an expression regarding the merits of your
case. Your signature acknowledges only that you received a copy of this
completed information sheet and does not mean you have hired the
Attorney. The matters you have divulged to us we shall consider as
confidential.

☐ I acknowledge that completion of this form does not mean that I have
hired this firm or any attorney working for this firm. I understand that
unless and until both myself and the Attorney have executed a written
Agreement for Representation, neither firm nor any attorney working for
this firm represents me in this matter.
Data Privacy Statement

The Law Firm acknowledges its responsibilities pursuant to Republic


Act No. 10173 or the Data Privacy Act of 2012 with regard to data
processing from collection to destruction and further ensuring that all
information of the data subjects are processed in adherence to the general
principles of transparency, legitimacy, and proportionality. Also, the Law
Firm recognizes the rights of the data subject to: a) be informed, b) object,
c) access, d) correct, and e) rectification, erasure, or blocking.

The personal data obtained from the data subject is processed,


entered, and stored indefinitely within the Law Firm’s authorized systems
and processes for documentation and case matter administration and will
only be accessed and used by authorized personnel and the clerks of the
Law Firm.

Declaration of Consent:

In view of the foregoing and in connection with our engagement with


the Law Firm for this particular instance, I hereby give the Law Firm my
consent to use, store, update, or modify, process, disclose, or share my
personal data such as but not limited to the following personal information
name, age, date of birth, civil status, religion, address, contact numbers and
other contact information, corporate/business records – as requested by as
requested by its proper authorities and subsidiaries.

Name of Client: full name


Customary mark/signature/e-signature/image of wet signature:

Date: mm/dd/yy

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