Thank you for choosing Cohen Halsey LLLC. Completing this intake form will help us gather the essential information needed to understand your situation and provide you with the highest level of service.

Your accuracy and thoroughness in completing this form will allow us to advocate effectively on your behalf and ensure that nothing important is overlooked.

Please take your time to answer each question to the best of your ability. All information you provide will be kept strictly confidential and is used solely for the purpose of managing your legal matters.

We know that providing detailed information can take a little time, but rest assured that every detail you share strengthens our ability to serve you effectively. Our goal is to make the process as smooth and straightforward as possible while ensuring your case is organized, accurate, and ready for the next steps.

If you have questions while completing the form, please do not hesitate to reach out to our team—we’re here to help every step of the way.

Please read the privacy policy below, and then fill out this form in its entirety.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

Your personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

If you have any questions, please don't hesitate to contact our office. We look forward to working with you!

Client Information

Contact information

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First name *

Middle name

Last name *

Company

Emails

Email Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

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Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

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Phone numbers

Phone number

Type

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Background / General Information

Conflicts & Prior Representation

Goals & Expectations

Additional Information

Acknowledgment & Consent

By submitting this form, you acknowledge that the information provided is accurate to the best of your knowledge. Submission of this form does not create an attorney-client relationship. Such relationship will only be established upon execution of a formal engagement agreement.

You also consent to being contacted by our firm regarding your inquiry.

Client Information

Contact information

Preferred name / nickname

Preferred method of contact

Background / General Information

How did you hear about our firm?

Please provide a brief description of your legal matter and how we can help.

Names of other parties involved in your legal matter (individuals, businesses, etc.).

If our law firm ends up representing you in this matter, will you be the person who pays the legal fees?

Conflicts & Prior Representation

Have you previously worked with our firm?

Have you consulted or retained another attorney for this matter?

Goals & Expectations

What are you primary objectives for this matter?

Are there any deadlines or time-sensitive factors we should know about?

Additional Information

Please share any additional details you believe may be helpful.

Acknowledgment & Consent

Please acknowledge that you have read and hereby accept the above privacy policy regarding the use of your personal information by typing your full legal name below.