INITIAL CLIENT CONSULTATION INTERVIEW FORM

The purpose of an initial consultation is for the attorney to advise you, the prospective client what, if anything, may be done for you, and what the minimum fee therefore will be. The purpose is not to render a definitive legal opinion as it may be impossible to fully assess a matter within the time frame allotted for a consultation or with the (information or documents) that you may be able to provide at the initial consultation.

One of three outcomes is possible following your consultation:

A. You and the Attorney mutually agree to the terms of representation, (After a separate document called an Agreement for Representation is signed, a copy will be provided to you.)

B. The Attorney declines representation, or

C. You decide not to use the services of the Attorney.

Note: The following questions will help me to understand the reason for your inquiry. Your responses are protected by attorney/client privilege and will be held in strict confidence.

First Name *

Last Name *

Address *

Phone *

E-mail Address *

Are there other parties involved? (Examples: a friend, an employer, a neighbor, signor of a contract, etc. This should include people or parties on either side of your issue)

Briefly explain what you may need advice about or assistance with today: *

List the documents (papers) that you think may help us to understand the issues.

Ideally, if things turn out precisely the way you want, what would the outcome be?

Knowing that there are no guarantees, what can you accept?

Please classify your urgency in concluding this matter: (Check One) *

Critical - Personal safety, personal finances or continuation of business depends on it.
Very important - Severe hardship, personal or financial inconvenience if matter is not resolved quickly.
Important - This matter interferes with business or personal financial stability.
This needs to be done, but no immediate hardship in the interim.
Just thought I’d see if it was worth pursuing, but I’m not counting on anything.
Just wanted to know what are my rights. I’ll then let you know after I think about it.

If the matter involves payment to you of money you feel you are owed, how long can you wait before not getting paid? ?

Am I the first attorney you have consulted regarding this matter?

Yes
No

If No - Why didn’t you hire their services?

Have you ever been represented by an attorney before?

Yes
No

If Yes - Please list the circumstances:

How will you pay for your attorney’s fees in this matter? *

Credit Card
Check
Cash
Contingency Fee

Marital Status: *

Married
Single
Divorced
Widowed
Separated

Driver’s License Number *

State of Issue *

Social Security Number

Are you known by any other names? *

Yes
No

If yes, what name(s): ?

Where are you employed?

May we contact you there?

Yes
No

Employer Phone Number

If your mail is returned as undeliverable or your telephone service terminated, please provide the name of someone (friend or relative) you believe will always know how to contact you.

Name *

Relationship *

Address *

Phone Number *

How did you learn of my office? *

A friend
Website
Bar Referral
Advertisement
Former Client
Other

PLEASE READ CAREFULLY and Sign Below

Following your initial interview, if you agree to hire the Law Office of Jessenia Rosales, LLC, and the Attorney Jessenia Rosales agrees to represent you, you will both sign an Agreement for Representation. The Agreement for Representation will set forth the terms and conditions of representation.

If the Attorney is willing to represent you and you decide not to sign an Agreement of Representation today, you are strongly urged to schedule a second appointment with the Attorney at the earliest possible time or to immediately consult with other legal counsel to protect your rights.

NOTICE: This office does not represent you with regard to the matters set forth by you herein in this information sheet or discussed during your consultation, unless and until, both you and the Attorney execute a written Agreement for Representation.

If the Attorney does not agree to represent you, this includes not representing you with regard to the matter set forth by you on this information sheet, or any other matters you may discuss with the Attorney during your consultation. If your legal problem(s) involve a potential lawsuit, it is important that you realize a lawsuit must be filed within a certain period of time called a Statute of Limitations. Therefore, the Attorney strongly urges you to immediately consult with another attorney to protect your rights. The Attorney’s decision not to represent you should not be taken by you as an expression regarding the merits of your case.

Your signature acknowledges only that you received a copy of this completed information sheet and does not mean you have hired the Attorney.

Prospective Client's Signature *

Prospective Client's Printed Name *

Date *

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