Client Intake Form

Congratulations on Selecting the McClure Law Group!

Complete the form to the left to allow us to create a file for you. Please be as complete as possible.

Your First Name *

Your Middle Name *

(if you have one otherwise enter "none")

Your Last Name *

(required - if you have more than one enter them all)

Your Date of Birth *

Month

Day

Year

Your Email Address *

Your Phone Number *

Your Street Address *

Your City *

Your State *

Your Zip *

Are you Legally Married? *

Can we contact your spouse? *

Spouse First Name

Spouse Middle Name

Spouse Last Name

Spouse Date of Birth

Month

Day

Year

Spouse Email

Spouse Phone Number

Spouse Street Address

(if different)

Spouse City

Spouse State

Spouse Zip

Legal Services Requested *

Your Message *

Math question * 3 + 4 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.