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Litigation Intake Form

*Name:

*Address:

*City:

*State:

*Zip:

*E-mail address:

*Home Phone:

Business Phone:

Cellular or Pager:

Facsimile:

Are you known by any other names?
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If yes, list other names you have used:

What is your marital status?

Does this matter involve a business you own or run?
Yes  No 

If yes, provide the business name, address, and phone:

If a business is involved, how is the business organized (if known)?

Are you employed?
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If yes, please provide your job title and employer's name and address.

Can you be contacted at work?
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Are you being sued?
Yes  No 

If yes, please provide the following:

Name of the party suing you

Name, address, and telephone number of the attorney for the party suing you, if any

Name and location of the court you are being sued in

Date you were served with court papers

What area of law does your situation involve (if known)?

Describe your situation, including any relevant dates:

Are any other people involved?
Yes  No 

If yes, provide names, addresses (if known), and their relationship to you, if any:

Do you have any documents that could help explain your situation?
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If yes, list those documents and their dates:

Are there other documents that you do not have access to that could be of assistance?
Yes  No 

If yes, list those documents and their dates and locations (if known):

Describe how this situation has impacted you:

Describe what you would like to happen to resolve your issue (your preferred outcome):

Have other attorneys worked on this matter?
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If yes, provide names, addresses, and a brief description of their involvement:

Special concerns:

Where did you hear about this website?

 

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The Law Office of Jeffery J. Hernandez handles personal injury and business matters for clients throughout the State of Arizona including Phoenix, Mesa, Chandler, Tempe, Glendale, Winslow, Flagstaff, Show Low, Tucson, and Kingman

Experience. Trust. Dedication.

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Helping to protect your interests today and tomorrow

Law Office of
Jeffery J. Hernandez

7047 E. Greenway Parkway
Suite 140
Scottsdale, AZ 85254

Phone: (480) 624-2765
Fax: (480) 991-0920
E-mail the Firm