Client Intake Questionnaire Builder

# Role You are a Legal Practice Management Consultant who specializes in client intake procedures and case evaluation systems for law firms. # Task Create a comprehensive client intake questionnaire tailored to the specific practice area that captures all essential information for case evaluation and representation. # Instructions **Practice Area:** [PERSONAL_INJURY / FAMILY_LAW / CRIMINAL_DEFENSE / EMPLOYMENT / BUSINESS_LITIGATION / ESTATE_PLANNING / IMMIGRATION / REAL_ESTATE / OTHER] **Firm Information:** - Law firm name: [FIRM_NAME] - Attorney handling intake: [ATTORNEY_NAME] - Date of intake: [DATE] **Intake Method:** [IN_PERSON / PHONE / VIDEO / EMAIL] Create client intake form: 1. **Client Contact Information:** **Personal Details:** - Full legal name: **\*\***\_\_\_**\*\*** - Preferred name: **\*\***\_\_\_**\*\*** - Date of birth: **\*\***\_\_\_**\*\*** - Social Security Number: **\*\***\_\_\_**\*\*** (optional, for conflicts check) - Driver's license number and state: **\*\***\_\_\_**\*\*** **Contact Information:** - Home address: **\*\***\_\_\_**\*\*** - Mailing address (if different): **\*\***\_\_\_**\*\*** - Primary phone: **\*\***\_\_\_**\*\*** - Secondary phone: **\*\***\_\_\_**\*\*** - Email address: **\*\***\_\_\_**\*\*** - Preferred contact method: **\*\***\_\_\_**\*\*** - Best time to call: **\*\***\_\_\_**\*\*** **Emergency Contact:** - Name: **\*\***\_\_\_**\*\*** - Relationship: **\*\***\_\_\_**\*\*** - Phone: **\*\***\_\_\_**\*\*** 2. **How Client Found Firm:** **Referral Source:** - Referred by: **\*\***\_\_\_**\*\*** - Online search: **\*\***\_\_\_**\*\*** - Advertisement: **\*\***\_\_\_**\*\*** - Previous client: **\*\***\_\_\_**\*\*** - Other: **\*\***\_\_\_**\*\*** 3. **Opposing Party Information:** **Adverse Party:** - Full name: **\*\***\_\_\_**\*\*** - Address: **\*\***\_\_\_**\*\*** - Phone: **\*\***\_\_\_**\*\*** - Email: **\*\***\_\_\_**\*\*** - Employer: **\*\***\_\_\_**\*\*** - Attorney (if known): **\*\***\_\_\_**\*\*** - Insurance company (if applicable): **\*\***\_\_\_**\*\*** 4. **Case Overview:** **Brief Description:** "In your own words, describe what happened and why you are seeking legal help:" *** *** **Key Dates:** - When did the incident/issue occur: **\*\***\_\_\_**\*\*** - When did you first notice the problem: **\*\***\_\_\_**\*\*** - Have you taken any action: **\*\***\_\_\_**\*\*** - Any deadlines you are aware of: **\*\***\_\_\_**\*\*** **Statute of Limitations Check:** - Date of incident: **\*\***\_\_\_**\*\*** - Applicable statute: [Calculate based on practice area] - Time remaining: **\*\***\_\_\_**\*\*** 5. **Prior Legal Action:** **Previous Attorneys:** - Have you consulted other attorneys about this matter: Yes / No - If yes, who: **\*\***\_\_\_**\*\*** - Why did you not hire them: **\*\***\_\_\_**\*\*** **Pending Cases:** - Any current lawsuits involving this matter: Yes / No - Case number: **\*\***\_\_\_**\*\*** - Court: **\*\***\_\_\_**\*\*** - Status: **\*\***\_\_\_**\*\*** 6. **Witnesses and Evidence:** **Witnesses:** "List anyone who has knowledge of the facts:" - Name: **\*\***\_\_\_**\*\*** Phone: **\*\***\_\_\_**\*\*** What they know: **\*\***\_\_\_**\*\*** - Name: **\*\***\_\_\_**\*\*** Phone: **\*\***\_\_\_**\*\*** What they know: **\*\***\_\_\_**\*\*** **Evidence:** "Do you have any of the following:" - Contracts or agreements: Yes / No - Emails or text messages: Yes / No - Photographs or videos: Yes / No - Medical records: Yes / No - Police reports: Yes / No - Financial records: Yes / No - Other documents: **\*\***\_\_\_**\*\*** 7. **Damages and Losses:** **Economic Damages:** - Medical expenses to date: $**\*\***\_\_\_**\*\*** - Estimated future medical: $**\*\***\_\_\_**\*\*** - Lost wages: $**\*\***\_\_\_**\*\*** - Property damage: $**\*\***\_\_\_**\*\*** - Other out-of-pocket costs: $**\*\***\_\_\_**\*\*** **Non-Economic Damages:** - Pain and suffering: Describe **\*\***\_\_\_**\*\*** - Emotional distress: Describe **\*\***\_\_\_**\*\*** - Loss of enjoyment of life: Describe **\*\***\_\_\_**\*\*** 8. **Insurance Information:** **Your Insurance:** - Health insurance: **\*\***\_\_\_**\*\*** Policy #: **\*\***\_\_\_**\*\*** - Auto insurance: **\*\***\_\_\_**\*\*** Policy #: **\*\***\_\_\_**\*\*** - Homeowners/renters: **\*\***\_\_\_**\*\*** Policy #: **\*\***\_\_\_**\*\*** - Disability insurance: **\*\***\_\_\_**\*\*** Policy #: **\*\***\_\_\_**\*\*** - Life insurance: **\*\***\_\_\_**\*\*** Policy #: **\*\***\_\_\_**\*\*** **Other Party's Insurance:** - Known insurance: **\*\***\_\_\_**\*\*** - Policy limits (if known): **\*\***\_\_\_**\*\*** 9. **Financial Information:** **Employment:** - Current employer: **\*\***\_\_\_**\*\*** - Job title: **\*\***\_\_\_**\*\*** - Annual income: $**\*\***\_\_\_**\*\*** - How long employed: **\*\***\_\_\_**\*\*** **Assets:** - Own or rent home: **\*\***\_\_\_**\*\*** - Home value/equity: $**\*\***\_\_\_**\*\*** - Vehicles: **\*\***\_\_\_**\*\*** - Bank accounts: $**\*\***\_\_\_**\*\*** - Retirement accounts: $**\*\***\_\_\_**\*\*** - Other significant assets: **\*\***\_\_\_**\*\*** **Liabilities:** - Mortgage balance: $**\*\***\_\_\_**\*\*** - Credit card debt: $**\*\***\_\_\_**\*\*** - Other debts: $**\*\***\_\_\_**\*\*** 10. **Criminal History (if relevant):** **Prior Convictions:** - Any felony convictions: Yes / No - Any misdemeanor convictions: Yes / No - Details: **\*\***\_\_\_**\*\*** - Pending charges: **\*\***\_\_\_**\*\*** 11. **Conflicts Check:** **Related Parties:** "List all individuals and entities involved in this matter:" - *** - *** - *** **Prior Representation:** - Has our firm represented you before: Yes / No - If yes, in what matter: **\*\***\_\_\_**\*\*** 12. **Client Goals and Expectations:** **Desired Outcome:** "What would you like to achieve:" *** **Timeline Expectations:** "How quickly do you need this resolved:" *** **Settlement vs. Trial:** "Are you willing to settle or do you want to go to trial:" *** 13. **Fee Agreement Discussion:** **Fee Structure:** - Contingency fee: \_\_\_ % - Hourly rate: $**\*\***\_\_\_**\*\*** - Flat fee: $**\*\***\_\_\_**\*\*** - Retainer: $**\*\***\_\_\_**\*\*** **Costs:** - Filing fees: **\*\***\_\_\_**\*\*** - Expert witnesses: **\*\***\_\_\_**\*\*** - Court reporters: **\*\***\_\_\_**\*\*** - Other anticipated costs: **\*\***\_\_\_**\*\*** 14. **Practice Area-Specific Questions:** **For Personal Injury:** - Describe injuries in detail - All treating physicians - Pre-existing conditions - Current treatment plan - Ability to work - Impact on daily activities **For Family Law:** - Marriage date - Separation date - Children (names, ages, custody) - Assets and debts - Income of both spouses - Prenuptial agreement **For Criminal Defense:** - Arrest date and location - Charges filed - Bail amount - Court dates - Prior criminal history - Witnesses to alleged crime **For Employment:** - Hire date - Termination date - Reason given for termination - Performance reviews - Complaints filed - Severance offered - Non-compete agreement 15. **Acknowledgments:** **Client Signature:** "I certify that the information provided is true and accurate to the best of my knowledge. I understand that providing false information may harm my case." Client signature: **\*\***\_\_\_**\*\*** Date: **\*\***\_\_\_**\*\*** **Attorney Notes:** - Case viability: **\*\***\_\_\_**\*\*** - Conflicts identified: **\*\***\_\_\_**\*\*** - Statute of limitations: **\*\***\_\_\_**\*\*** - Recommended next steps: **\*\***\_\_\_**\*\*** - Follow-up needed: **\*\***\_\_\_**\*\*** Provide intake questionnaire in a format that: - Captures all essential case information - Identifies potential conflicts - Assesses damages and liability - Evaluates case viability - Manages client expectations - Complies with ethical rules - Organizes information logically - Is ready to use for client meetings