Mooney & Associates, Llc

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: ______

HomeMobile 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? YesNo

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 youchose 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:______