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Case and attorney

Attorney handling your case(Required)

Select the attorney who is handling your case.

Court where case is pending

Case number

Judge

Prosecutor or AUSA

Next hearing type, date, and time

Basic client information

First name(Required)

Last name(Required)

Middle name

Age

Date of birth

Place of birth

Home phone

Work phone

Cell phone

Email address(Required)

Preferred pronouns

Residence and referral

Home address

Do you own or rent your home?

How long have you lived there?

Mailing address (if different)

States where you have lived and dates

Names and relationships of everyone who lives with you

How did you hear about our firm?

Referring person or firm, or website where you found us

If referred, whom were you told to call?

Other referral details

Phone number you called to reach us

Marriage or partnership

Marital or partnership status

Partner or spouse name

Partner or spouse address if different

Length of relationship

Partner or spouse home phone

Partner or spouse work phone

Partner or spouse cell phone

Children

Child 1: full name, age, current residence, co-parent name, whether the child lives with you, and financial support

Child 2: full name, age, current residence, co-parent name, whether the child lives with you, and financial support

Child 3: full name, age, current residence, co-parent name, whether the child lives with you, and financial support

Child 4: full name, age, current residence, co-parent name, whether the child lives with you, and financial support

Child 5: full name, age, current residence, co-parent name, whether the child lives with you, and financial support

Child 6: full name, age, current residence, co-parent name, whether the child lives with you, and financial support

Other dependents

Other dependent 1: name, relationship, residence, and support you provide

Other dependent 2: name, relationship, residence, and support you provide

Other dependent 3: name, relationship, residence, and support you provide

Other dependent 4: name, relationship, residence, and support you provide

Other dependent 5: name, relationship, residence, and support you provide

Relatives and friends

Mother: name, relationship, and whether in Michigan (city if yes)

Father: name, relationship, and whether in Michigan (city if yes)

Sibling 1: name, relationship, and whether in Michigan (city if yes)

Sibling 2: name, relationship, and whether in Michigan (city if yes)

Sibling 3: name, relationship, and whether in Michigan (city if yes)

Sibling 4: name, relationship, and whether in Michigan (city if yes)

People we may contact about your case

Authorized contact 1: name, relationship, phone, email, and what we may discuss

Authorized contact 2: name, relationship, phone, email, and what we may discuss

Authorized contact 3: name, relationship, phone, email, and what we may discuss

Important case precautions

Do not discuss your case on jail calls or email, or with other people at the jail. Do not contact witnesses or co-defendants. Do not speak with police, prosecutors, or other law enforcement agents about the case without speaking to your lawyer. Do not call the court about your case; contact our office. If your case concerns drugs or alcohol, avoid their use while the matter remains pending. Call us with questions, even if you have not received a recent update.

Current employment

Are you currently employed?

Employer name and address

How long have you worked there?

Job title

If unemployed, how long?

If unemployed, are you searching for work?

Upcoming interviews and employer

How are you supporting yourself?

Work responsibilities

Has the case or arrest affected your employment? If yes, how?

Prior employment, most recent first

Prior job 1: employer name and address, phone, supervisor, kind of work, income, reason for leaving, and whether we may call

Prior job 2: employer name and address, phone, supervisor, kind of work, income, reason for leaving, and whether we may call

Prior job 3: employer name and address, phone, supervisor, kind of work, income, reason for leaving, and whether we may call

Property ties to Michigan

Do you own, lease, or rent a home, condominium, business establishment, or other property in Michigan? Describe each property and your interest in it.

Military service

Military history: branch, service dates, discharge type, highest rank, awards, and decorations

Prior cases and court appearances

Prior case 1: charge, date, outcome or convictions, bond amount and violations, probation and violations, attorney, and any failure to appear

Prior case 2: charge, date, outcome or convictions, bond amount and violations, probation and violations, attorney, and any failure to appear

Prior case 3: charge, date, outcome or convictions, bond amount and violations, probation and violations, attorney, and any failure to appear

Prior case 4: charge, date, outcome or convictions, bond amount and violations, probation and violations, attorney, and any failure to appear

Arrests outside your home state

Details of any failure to appear or bond forfeiture

Successes or failures on bond, probation, supervised release, or parole

Dismissed, expunged, or suppressed prior cases or convictions

Citizenship and immigration, if you are not a U.S. citizen

Country of origin

Current U.S. citizenship or immigration status

Prior removals or deportations, dates, and outcomes

Green card, visa, or permanent resident status

Length of U.S. residence

Education

Highest grade completed

High school graduation year

College graduation year

GED: how and when obtained

School 1, most recent first: name, dates, degree earned, and whether still attending

School 2, most recent first: name, dates, degree earned, and whether still attending

School 3, most recent first: name, dates, degree earned, and whether still attending

Were you attending school or planning to attend when arrested? Could you return if released?

Physical health

Do you currently have any physical health problems?

Physical conditions: diagnosis and date, treating physician, and medications for each

How have physical health conditions affected your quality of life?

Have you used alcohol or drugs to self-medicate physical conditions? Explain.

Mental health

Do you have any diagnosed or undiagnosed mental health conditions or concerns?

Mental health conditions: diagnosis, treating physician, and medications for each

How have mental health conditions affected your quality of life?

Have you used alcohol or drugs to self-medicate mental health conditions? Explain.

Do any family members have mental health conditions? Explain.

Alcohol and drugs

Describe your history of alcohol or drug use.

Do you currently use alcohol or drugs?

If you currently use drugs, when was your last use?

Past alcohol or drug treatment, including type and dates

Do you believe you have a problem with alcohol or drugs?

Would you consider treatment to support release on bond?

The incident or event

What are you accused of doing, and what actually happened? Please give a detailed account.

Community service and beliefs

Volunteer or charitable work: organizations, dates, duties, and contributions

Religious or spiritual affiliation or organization, if any: participation, leadership, and contributions

Anything else we should know

Tell us anything else about you or your family that might help your lawyer advocate for you, including activities, honors, awards, recognition, publicity, and accomplishments.

Acknowledgment

I confirm that my answers are accurate to the best of my knowledge and belief.(Required)

I agree

Signature (type your full name)(Required)

Date(Required)

Client Intake Questionnaire – Dickstein & Amberg (1)