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Client Intake Form

Please complete the form below to provide us iwht the information we need to begin working on your request.

Once you have subnmitted your reuqest, youw ill recive a copy for your records, and we will respond shortyl to confirm receipt.

Client Information

Primary Contact Name *Please fill the required field.

Street Address *Please fill the required field.

City *Please fill the required field.

State *Please fill the required field.

Zip *Please fill the required field.

Cell Phone *Please fill the required field.

Email *Please fill the required field.

Spouse Name

Street Address (if different)

Spouse City (if different)

State (if different)

Spouse Zip

Spouse Cell Phone

Spouse Email

Family Information (Heirs)

Child 1 Name

Child 1 Cell Phone

Child 1 Email

Child 1 DOB

Child 1 Street Address (if different)

Child 1 City (if different)

Child 1 State (if different)

Child 1 Zip

Child 2 Name

Child 2 Cell Phone

Child 2 Email

Child 2 DOB

Child 2 Street Address (if different)

Child 2 City (if different)

Child 2 State (if different)

Child 2 Zip

Child 3 Name

Child 3 Cell Phone

Child 3 Email

Child 3 DOB

Child 3 Street Address (if different)

Child 3 City (if different)

Child 3 State (if different)

Child 3 Zip

Referral Information

How did you hear about Stalions Law?

Thank you for considering STALIONS LAW to represent you. All information that you disclose is confidential and privileged. It is important that you supply as much information as possible in order to adequately advise you. You hereby authorize and consent to communication by email and/or text messages and acknowledge that such methods of communication may not be secure. Please understand that unless a retainer agreement is executed, this initial communication will be considered a consultation. As a consultation, the information and advice that you receive is based upon the current status of the law as applied to the information you supply, and I am under no obligation to inform you of future changes in the law or to perform any legal services. If you choose to retain my services, the fee schedule will be discussed with you. STALIONS LAW reserves the rights to request compensation for this consultation should you choose not to proceed with representation.

By checking this box, you agree that the information above is accurate to the best of your knowledge, and you agree to the terms laid out in the paragraph above. *

I agree to the terms above

Submission Date *Please fill the required field.

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Client Intake Form

Client Information

Family Information (Heirs)

Referral Information

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