Crosse Law Office, P.C.

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Criminal Information Intake Form Personal Injury Questions CRIMINAL INFORMATION INTAKE FORM You do not have to judge the merits of your case alone. If you have any legal questions, please contact us by completing the following form. We'll get back to you as soon as possible. For quickest response, please call us at (303) 839-1137. NOTE: The use of the Internet for communications with the firm will not establish an attorney-client relationship. Messages containing confidential or time-sensitive information should not be sent. CLIENT INFORMATION
Address:
Date of Birth:
City:
State:
Zip Code:
Phone Numbers
Home:
Work:
Other:
Employer:
Employer Address:
City:
State:
Zip:
Job Title:
Spouse's or Significant Other's Name:
Emergency Contact:
Phone Number:
Are you currently represented by an attorney:
If so, by whom?
And why are you seeking new counsel?
How did you hear about us?
What issues do you need our help with?
INCIDENT INFORMATION
Date of the alleged incident:
Location of alleged incident:
City:
County:
State:
Please provide a brief description of the alleged incident:
Any witnesses to the alleged incident?
If so, state names and addresses below:
Name:
Telephone:
Name:
Telephone:
Name:
Telephone:
COURT INFORMATION
Have you already appeared (or should you have appeared) at any previous court hearings or proceedings regarding the alleged criminal matter referenced above: Yes No
If you answered "yes" to the above question, please identify the date of the court hearing, the nature of the court hearing, and any result and/or disposition which was reached at the court hearing:
Do you have any upcoming hearings or proceedings regarding the alleged criminal matter referenced above: Yes No
If you answered "yes" to the above question, please identify the date and nature of the court hearing:
Click here to submit this form PERSONAL INJURY QUESTIONS You do not have to judge the merits of your case alone. If you have any legal questions, please contact us by completing the following form. We'll get back to you as soon as possible. For quickest response, please call us at (303) 839-1137. NOTE: The use of the Internet for communications with the firm will not establish an attorney-client relationship. Messages containing confidential or time-sensitive information should not be sent.
Address:
City, State, Zip:
Phone Number:
How were you injured?
When were you injured?
What injuries did you suffer?
Where were you treated for your injuries?
What doctor(s) did you see?
Are you still being treated for your injuries?
Who else was involved in the accident/incident?
Did the other person receive a ticket/citation?
Were the police involved?
If so, what department?
Did you make a statement? Yes No
Type your message:
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NOTE: The use of the Internet for communications with the firm will not establish an attorney-client relationship. Messages containing confidential or time-sensitive information should not be sent.

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