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Client Intake Form

The purpose of an initial consultation is for HLA 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 HLA mutually agree to the terms of representation, or (After a separate document called an Agreement for Representation is signed a copy will be provided to you.)

(B) HLA declines representation, or

(C) You decide not to use the services of HLA.

Note The following questions will help us to understand how we can help you. Your responses are protected by attorney/client privilege and will be held in strict confidence.

1. Name
2. Address Are You In Ethiopia
3. Contact Address
4. Relationship Status
Single
Married
Divorced
Widowed
5. Driver License
6. Are you known by any other names?(like Nick name)
Yes
No
7. Where are you employed? (Name of company/organization, name of supervisor, address) May we contact you there?
Yes
No
8. If your mail is returned as undeliverable or telephone service terminated, please provide the name of someone (friend or relative) you believe will always know how to contact you.
9. Briefly explain what you may need advice about or assistance with today
10. Are there any parties involved?(Family,Friend,Any)
1
2
3
11. Your urgency in concluding this matter?
Critical – Personal safety or continuation of business depends on it.
Very important – severe hardship, personal or financial inconvenience if matter is not resolved quickly.
Important – Matter interferes with business or personal financial stability.
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 my rights are? I’ll then let you know after I think about it.
13. If the matter involves payment of money you feel you are owed, how long can you wait before not getting paid?
Days
Weeks
Months
Years
14. Are we the first attorneys you have consulted regarding this matter?
Yes
No
15. Have you ever been represented by an attorney before?
Yes
No
✓ Your Submition to this form acknowledges only that you received a copy of this completed information sheet and does not mean you have hired the Attorney.
I acknowledge that completion of this form does not mean that I have hired this firm or any attorney working for this firm. I understand that unless and until both myself and the Attorney have executed a written Agreement for Representation, neither firm nor any attorney working for this firm represents me in this matter