Prospective Client Intake Form

Thank you for choosing the CGA Law Firm. Please use this form to complete the client intake process prior to your consultation.

Choose an area of Law(Required)

Acknowledgement of Notices(Required)

I acknowledge receipt of the “CGA Initial Consultation Policy,” the “Financial Arrangements with Clients” notice which governs payment of fees and costs including fees for the initial consultation, and the “Notice Concerning Privacy and Confidentiality of Information”.

Disability Disclosure

Check here if you require a disability-related accommodation in order to access legal services.

Identify the requested accommodation:

Client Information

Name(Required)

First Last Middle Initial

Married

Check here if your spouse is also part of this matter

Address(Required)

Street Address City State ZIP Code

Township/Borough

Home Phone Number

Work Phone Number

Cell Phone Number

Fax Number

Email

Preferred Method of Contact(Required)

Please select which of the above contact methods you’d prefer we use to get in touch with you

Date of Birth(Required)

Employment Information

Employer Name(Required)

Employer Address

Street Address City State ZIP Code

Occupation(Required)

Spouse's Information

Spouse's Name(Required)

First Last Middle Initial

Same Address?(Required)

Yes

No

Do you and you and your spouse share an address? Select one.

Spouse's Address(Required)

Street Address City State ZIP Code

Spouse's Township/Borough

Spouse's Home Phone Number

Spouse's Work Phone Number

Spouse's Cell Phone Number

Spouse's Fax Number

Spouse's Email(Required)

Spouse's preferred method of contact(Required)

Spouse's Date of Birth(Required)

Spouse's Employment Information

Spouse's Employer Name(Required)

Spouse's Employer Address(Required)

Street Address City State ZIP Code

Spouse's Occupation(Required)

Newsletter

Newsletter delivery method

Check here to receive CGA newsletters and updates via mail

Check here to receive CGA newsletters and updates via email

Please choose the method through which you’d like to receive our newsletter

Prospective Client Intake Form