Intake Form: Client Information

Email *

First Name *

Last Name *

Phone *

Address

Address *

City

State

Country

Postal code

Date of birth

How did you hear about us? *

Preferred method for contact

Employment Information

Are you Employed? *

Yes

No

Legal Matter Details

Type of Law *

Type of Matter(s)

Do you have a Case Number? *

Yes

No

Have you had prior counsel regarding this matter? *

Yes

No

Secondary Contact

Can you please provide a backup contact? *

Yes

No

Secondary Contact: Relation to You

Opposing Party Information

Can you provide information about the opposing party? *

Yes

No

Is Opposing Party Employed? *

Yes

No

Does Opposing Party have an Attorney?

Yes

No

Not Sure

Document Upload

Attachment

Please upload any documents relevant to this matter.

CONSENT CHECKBOX - Consents to receiving communications from Gillespie, Shields & Tylor, including emails, text messages, and phone calls, for the purpose of receiving updates, important information, and legal assistance related to my inquiry or case.

Intake Form: Client Information

Employment Information

Secondary Contact

Opposing Party Information

Submit