Intake Sheet, Regional Law Center
This intake form was created directly from an Excel spreadsheet. It is here, however, a pure 'html' form. P
lace 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:
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