Client Intake Form Home Forms Name* First Middle Last Address* Street Address City State / Province / Region ZIP / Postal Code Home PhoneMobile Phone*Work PhoneFacsimileEmail* Marital Status*SingleMarriedDivorcedWidowedAre you a veteran?*YesNoIs your spouse a veteran?*YesNoOccupation*Employer*Is it okay to contact you at work?*YesNoEmergencies onlyWhat kind of representation are you requesting?* Tax Controversy (Representation Before the IRS or United States Tax Court) Estate Planning (Wills, Trusts, Powers of Attorney, Advance Directives, Etc.) Medicaid, Nursing Home, or Long-Term Care Planning Special Needs Planning Veterans Administration Pension Planning Business Entity Formation or Reformation (Corporations, LLCs, Partnerships) Other If you answered "Other," describe what you are requesting assistance with below.*How did you learn about our firm?