Criminal Defense Intake Form

Complete this form before your consultation to help us prepare for your criminal defense matter.

Please complete all applicable fields. This form collects information about your criminal matter. All information is confidential. Fields marked with * are required.

Your Contact Information

Full Name *

Phone *

Client Information

Maiden Name

Date of Birth

Address

Social Security Number

Employer

Title / Position

Current Charges

Charges *

KRS (Statute Number)

County

Date of Charge

Description of Incident

Has a plea been entered?

Yes No

Plea Details

Criminal History

Any prior felony convictions?

Yes No

Prior Charges

County

Date

Additional Notes

Notes

Submitting this form does not create an attorney-client relationship. All information provided is kept confidential.

Ready to Schedule Your Consultation?

Complete your intake form, then contact our office to book your appointment.

Schedule a Consultation Call: 859-813-5614