Client Information

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Client's Name

Case number(s) & county/counties/city/cities

Date of Birth

Age

gender

Male
Female

ssn

Your form will also be emailed to this address.

Citizenship

Aliases/Nicknames

Address

Address Line 1

Address Line 2

City

State

Zip Code

Driver's License Number

State

Class

Cell Phone

Family Information

Marital Status

Spouse's Name

Spouse's Address

Address Line 1

Address Line 2

City

State

Zip Code

Children

Names, ages & gender

Parents

Names, contact info, whether they're living, and whether you keep in touch with them

Siblings

Names, ages, & whether you're close to them

First Alternate Contact

First alternate name

Relationship

Address

Address Line 1

Address Line 2

City

State

Zip Code

First Alternate Phone

Second Alternate Contact

Second alternate contact name

Second relationship

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Employment

Employer

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor's Name

Ok to call you at work?

Income

Frequency

Weekly
Montly
Biweekly

long

Previous Employer

Bond

Status of Bond

Type of Bond

Bond set at $

Bondsman's Name

Bondsman's Phone Number

Criminal History

Arrests & Convictions

List all arrests and convictions. Include date, location (city/county/state), and case number (if known).

Probation & Parole

Are you currently on probation/parole/a suspended sentence/a deferred sentence/post-imprisonment supervision or have any other pending charges? List charges, status, case number, and location.

Mitigation

Mental Health

Have you ever been under the care of a psychiatrist/doctor/psychologist or been treated for mental illness? If so, when and where? Include any prescriptions affecting mental ability.

Current Health

Do you have any physical disabilities or illnesses? Are you taking any medication? Please List.

Alcohol & Drug Use

Have you ever been treated for an alcohol or drug problem? If so, when and where? In your opinion, was the treatment successful? Include any treatment programs attended as part of probation or earlier prison time.

Military History

Include branch, whether active/guard/reserve, rank, honors/medals, type of discharge, entry date(s), discharge date(s).

Education

Level of education & anything you are currently working on. Include last grade/degree completed, when, & where.

Community Involvement

Volunteer work, church involvement, etc.

Situation Growing Up

Briefly tell me your life story. Begin from when you were born; tell me about the way you grew up; tell me about your parents, family, spouse, children, teachers, friends, employers, and anyone else significant for both good and bad reasons; tell me about your life today and what caused you to be here. Include any history of abuse, living in foster care, etc.

References

List name & contact info for anyone who you think could provide a positive reference for you Employer, teacher, pastor, community leader, volunteer organization member, etc.

Any other questions or issues that you'd like to discuss with me?

Is there anything else that I should know that could be helpful in your defense?

Representation Goals

List your goals for this representation (besides dismissal). Stay out of jail, not go to trial, not become a convicted felon, shortest time possible on probation, not lose CDL, eligible for expungement, treatment for drug addiction, etc.

Name