Client Intake Form | Lowenthal APC

Client No. 1*

First Last

Address 1*

Address 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address

Phone

Phone Type

Work
Home
Cell

Communication Preference

Phone
Email

Client No. 2
First Name Last Name

Address 1
Address 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address

Phone

Phone Type
Work
Home
Cell

Communication Prefrence
Phone
Email

Please Briefly Describe Your Legal Matter

*

Conflict of Interest Disclosure

The relationship between attorney and client creates a fiduciary duty that limits the attorney’s ability to take on the representation of clients whose interests may be adverse to those of existing clients, former clients, the attorney, or the attorney’s firm. Conflicts of interest arise when an attorney’s performance of his or her duties is inhibited. Please help us avoid potential or actual conflicts of interest and provide us with information regarding any opposing or related party to the above-described matter.

Party No. 1

Name
First Name Last Name

Relationship

Address
Address 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Phone Type
Work
Home
Cell

Email

Party No. 2

Name
First Name Last Name

Relationship

Address
Address 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Phone Type
Work
Home
Cell

Email

Party No. 3

Name
First Name Last Name

Relationship

Address
Address 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Phone Type
Work
Home
Cell

Email

Supplemental Information

Have you conferred with another attorney about this matter?*
Yes
No

Have you had any previous contact with this firm's office?*
Yes
No

Please let us know how you were referred to our office:
ARAG
Lawyers.com
Martindale-Hubbell
Nolo
Google
Yelp
Avvo
LinkedIn
Davis Wiki
Davis Enterprise
* Former Client
* Referral
* Other

Former Client/Referral/Other

Other Opposing or Related Party Information

Disclaimer

Please do not include confidential or sensitive information in your submission. In the event that we are representing a party with opposing interests to your own, we may have a duty to disclose any information you provide to our client.

ACKNOWLEDGMENT AND ACCEPTANCE*
I acknowledge that I have read and hereby accept the above Terms and Conditions of Initial Consultation.