Skip to content
Call Us Now :
972-757-7758
Home
Practice Areas
Criminal Defense
Facing Felony
Misdemeanor Offenses
Assault Family Violence
Theft Crimes
Sexual Assault of a Child
Drug Crimes
DWI
Expungements
Non-Disclosures
Federal Crimes
Sexual Assault
Probation Violations
Solicitation of a Minor
Solicitation of Prostitution
Juvenile Criminal Defense
Occupational Driver’s License
Attorneys
About Reggie London
London’s Practice Areas
Reggie London’s Approach
Contact Reggie London
Intake Forms
Juvenile Intake Form
Criminal Law Intake Form
Blogs
About Us
Testimonials
FAQs
Contact Us
Menu
Home
Practice Areas
Criminal Defense
Facing Felony
Misdemeanor Offenses
Assault Family Violence
Theft Crimes
Sexual Assault of a Child
Drug Crimes
DWI
Expungements
Non-Disclosures
Federal Crimes
Sexual Assault
Probation Violations
Solicitation of a Minor
Solicitation of Prostitution
Juvenile Criminal Defense
Occupational Driver’s License
Attorneys
About Reggie London
London’s Practice Areas
Reggie London’s Approach
Contact Reggie London
Intake Forms
Juvenile Intake Form
Criminal Law Intake Form
Blogs
About Us
Testimonials
FAQs
Contact Us
Call Us Now :
972-757-7758
Home
Practice Areas
Criminal Defense
Facing Felony
Misdemeanor Offenses
Assault Family Violence
Theft Crimes
Sexual Assault of a Child
Drug Crimes
DWI
Expungements
Non-Disclosures
Federal Crimes
Sexual Assault
Probation Violations
Solicitation of a Minor
Solicitation of Prostitution
Juvenile Criminal Defense
Occupational Driver’s License
Attorneys
About Reggie London
London’s Practice Areas
Reggie London’s Approach
Contact Reggie London
Intake Forms
Juvenile Intake Form
Criminal Law Intake Form
Blogs
About Us
Testimonials
FAQs
Contact Us
Juvenile Intake Form
Juvenile Intake Form
Hidden
Next Steps: Sync an Email Add-On
To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.
Client Information
Name
(Required)
First
Date of Birth
MM slash DD slash YYYY
Age
Gender
Male
Female
Address
Street Address
Address Line 2
City
ZIP Code
Email
Phone
School Attending
MM slash DD slash YYYY
Parent/Guardian Name
First
Parent/Guardian Phone Number:
Emergency Contact Name
First
Emergency Contact Phone Number
Legal Information
Reason for Seeking Legal Representation
Date of Incident
MM slash DD slash YYYY
Location of Incident
Address Line 2
Law Enforcement Agency Involved
Case Number (if any)
Were Charges Filed?
Please Select
Yes
No
If yes, please provide details
Is the Juvenile currently detained?
Please Select
Yes
No
If yes, where?
Background Information:
Briefly describe the events leading to the incident
Has the Juvenile been involved in any prior legal issues?
Please Select
Yes
No
If yes, please provide details
Are there any court orders, such as restraining orders or probation, currently in effect?
Please Select
Yes
No
If yes, please provide details
Are there any other parties involved in the incident?
Please Select
Yes
No
If yes, please provide their names and contact information:
Additional Information
How did you hear about our firm?
Is there any other information you believe is important for us to know?
Consent
I, hereby confirm that the information provided above is accurate and complete to the best of my knowledge. I understand that this form is for the purpose of gathering initial information and does not establish an attorney-client relationship. I consent to the use of this information by [Law Firm Name] for the purpose of evaluating my case and contacting me regarding legal representation.