Thank you so much for contacting our law office! Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

Your Social Security Number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

Social Security Numbers are most often used to positively identify parties. Most courts require Social Security Numbers of all parties in a case. Some other examples of how this information may be used include:

initial service
in court orders
in required reports or other documents filed with the State

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!

Welcome to DRE A.P.C.

Welcome! To ensure our legal team can provide the best possible assistance, we’ve designed a few questions for you to complete. Rest assured, your responses are confidential and shared only with you.

Feel free to be as detailed as you'd like, and if there’s any information you prefer not to disclose in writing, simply make a note of it so we can follow up with you. Providing thorough information will help us better understand your situation and its importance to your case.

We appreciate your trust and cooperation. Thank you for choosing us!

Contact information

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Emergency Contact

Employment Information

Case Information

Legal History

Incident Details

Representation Expectations

Financial Information

THANK YOU

Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We will contact you as soon as possible with any updates.

Please click the SUBMIT button below when you have finished answering all questions.

Welcome to DRE A.P.C.

Contact information

Preferred Contact Method

Gender

Social Security Number

Driver's License Number

Marital Status

Emergency Contact

Name:

Relationship to Client:

Phone #:

Email Address:

Home Address:

Employment Information

Are you currently employed?

How were you referred to our law firm?

Case Information

Date of Incidenet:

Location of Incident:

Charges Filed (if known):

Case Number (if applicable):

Arresting Agency:

Have you been arrested? (Yes/No)

If you were arrested, was bail posted?

Court Location:

Next Court Date:

Legal History

Have you ever been convicted of a crime?

Do you have any other pending cases?

Are you on parole or probation?

Incident Details

Briefly describe what happened:

Were there any witnesses?

Were you questioned by law enforcement?

Did you make any statements?

Do you have any evidence (e.g., photos, videos, documents)?

Representation Expectations

What are your primary concerns about this case?

What outcome are you hoping to achieve?

Do you qualify for a public defender?

Financial Information

If our law firm ends up representing you in this matter, will you be the person who pays the legal fees?

PLEASE UPLOAD ANY ADDITONAL FILES BELOW

Please acknowledge that you have read and hereby accept the above privacy policy regarding use of my personal information by typing your full legal name below

THANK YOU