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AREAS OF PRACTICE
ONLINE FORMS
- CRIMINAL LAW FORM
- FAMILY LAW FORM
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CONTACT

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PRACTICE AREAS

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Criminal Law Form

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Referred by

Are you a

New Client

Prior Client

Type of offense

Misdemeanor

Felony

Criminal Traffic

Other

Type of offense

Date of arrest

County of arrest

Charges

Prior arrest/convictions

Yes

No

First Name:

Last Name:

Company

Title

Email Address

Home Phone

Work Phone

Cell Phone

Fax

Preferred method of contact

Phone

Email

Both

When is the best time to contact you?

Morning

Afternoon

Evening

Safe Mailing Address

Field label

New Field:

Field label

Free Text

Birth date

Driver's license number

Social Security Number

Free Text

Alternate/Emergency Contact

First Name

Last Name

Relationship to client

Phone

Email

Preferred method to receive billing statement

Mail

Email

Both

Free Text

Disclaimer*

I certify that the information provided is true and correct to the best of my knowledge.

New Field:

I agree

Brief description of incident(s) leading to arrest/charges

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Criminal Law Form

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OFFICE ADDRESS

PHONE

FAX