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Intake
Contact Us Template
Name
*
First
Last
*
Last
Number
Email
*
How did you hear about our office?
*
What is the best outcome/goal you are looking to accomplish?
*
Do you have any documents that are helpful?
Yes
No
Have you consulted another attorney regarding this matter?
Yes
No
If YES - Why did you not hire their services?
*
Have you ever been represented by another attorney before?
Yes
No
If YES - Please state the circumstance and attorney.
*
If you choose to reain with Randolph Law Firm, how do you plan to pay for the services?
Select One
Check today
Cash today
Contingency Fee
On account
Credit card
Debit Card
Monthly Payments
If you retain, do you have money in reserves to pay?
Yes
No
Can you borrow from family or friends?
Yes
No
Please verify the urgency in concluding this matter.
Select One
Very important - severe hardship, personal or financial inconvenience if matter is not resolved quickly
Needs to be done, but no immediate hardship in the interim
Just wanted to know what my rights are? I'll then let you know after I think about.
If you are human, leave this field blank.
Submit