Intake Sheet, Regional Law Center        
This intake form was created directly from an Excel spreadsheet. It is here, however, a pure 'html' form. Place this form on your website and direct a client or customer to it for completion. When the client/customer presses 'Submit,' the data can be sent directly back to you via email. Pathagoras can, in turn, convert the data into an Instant Database record.    
Date:     Court Data  
Client Name:     Plaintiff Name:  
Street Address1: Defendant Name:  
Street Address2: Court Locale  
City, ST ZIP Case Number  
Home Phone (Example: 8011234567)   DCSE Case Number  
Cell Phone (Example: 8011234567)   Marital Information:  
Work Phone (Example: 8011234567)   Date of Marriage  
Spouse Name:     Place of Marriage  
Street Address1: Date of Separation  
Street Address2: Date of SepAgree.  
City, ST ZIP  
Home Phone (Example: 8011234567)    
Cell Phone (Example: 8011234567)   Attorney Name  
Work Phone (Example: 8011234567)   Opp. Atty Name  
      Opp. Atty Address1  
How can we be of service to you? Opp.Atty Address2  
Example: Step-parent adoption   Opp.Atty CityStZip  
Other Information. Please list any other information you feel would be helpful, and/or anything you would like to discuss:  

Convert Excel spreadsheet to web form