MOONEY & ASSOCIATES
MOONEY & ASSOCIATES, LLC
CLIENT INTAKE SHEET
Date of Birth: _______________ Social Security No.: __________________ Date: __________________
Miss/Mr./Mrs./Ms. _________________________ _______________ ______________________________
(Circle One) First Name Middle Name Last Name
Home Address: _____________________________________________________________________________
County: ______________ City: _________________________ State: _______ Zip: __________
Email address: __________________________ Emails arrive much quicker than US mail & cost less for you!
Correspondence & Court Documents may be sent via email Yes No (circle one)
Telephone: _______________________ ______________________ ________________________
Home Mobile Business
*****Please circle preferred contact number*****
Please indicate work schedule: M T W TH F Hours: ________________________
Full Name of Opposing Party:________________________________________________________________
Date of Incident (if applicable): ______________
Prior Last Names, AKA’s or Aliases of Opposing Party: ____________________________________________
Please indicate nature of your Legal Issue: (if issue has an * please see receptionist for additional forms)
_____ Personal Injury (not vehicle related) PI _____ Civil Litigation CI*
_____ Workers Compensation WC _____ Criminal Defense CM*
_____ Personal Injury (motor vehicle related) MV _____ Summary Offense/DUI CM*
_____ Social Security SSI/SSD _____ Juvenile Offense CM
_____ Estate Administration & Probate EAD _____ Elder Issue/Guardianship ES
_____ Estate Planning (Will and/or related) BEP* _____ Prenuptial/Postnuptial Agt. FAM
_____ Real Estate Transaction RE _____ Family Law(Div,Cust,Supt,Adopt)FAM*
_____ Business Formation/Agreement BU _____ Immigration IM
______ Bankruptcy BK _____ Veterans Benefits VET
1. Have you ever been involved in a lawsuit or court action before? Yes No
2. Have you ever been involved in a matter in which Mooney & Associates represented the opposing party involved in your present legal issue? Yes No **If “yes”, List know details on back of this form.
3. Do you waive any conflict that Mooney & Associates may have if this law firm represents you in this matter?
4. Did you view our website prior to contacting us? Yes No
5. What TV station, if any, do you watch most often for local news? _______________________________
6. What radio station do you listen to most often? ________________________________________
7. Do you use a phone book and if so, which one? ________________________________________
Please indicate the reason you chose to consult with Mooney & Associates: Choose 1 Main Reason Only __Return Client __Referred by_______________________________________(Name & Relationship)
__Reputation of Attorney________________________(Name) __Website/Internet Search
__Convenient Office ____________________(Location) ___Extended Evening-Hrs. __No Appt. Needed __TV Ad __________________________________________________________(Station &/or Ad description)
__Telephone directory or Magnet(circle one) ____________________________(Name of Book and Location) __Billboard _________________________________________________ (Location/County & Describe Board) __Newspaper Ad: CPBJ ( ) Merchandiser( )/Franklin Shopper ( )Other print ad( )-Where _______________ __Chamber Ad ____________(Chamber) __School/Program Ad _______(Name) __ Radio ______(Station)
__Other Source ___________________________________________________________________________
For Office Use Only:
Paralegal: _______ Atty of Record: _______ Fee Agt Signed: ______
Comments:________________________________________________________________________________
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