General Intake Form

*Name:

*Address:

*City:

*State:

*Zip:

*E-mail address:

*Home Phone:

Business Phone:

Cellular or Pager:

Facsimile:

Are you known by any other names?
Yes  No 

If yes, list other names you have used:

What is your marital status?

Does this matter involve a business you own or run?
Yes  No 

If yes, provide the business name, address, and phone:

If a business is involved, how is the business organized (if known)?

Are you employed?
Yes  No 

If yes, please provide your job title and employer's name and address.

Can you be contacted at work?
Yes  No 

What area of law does your situation involve (if known)?

Describe your situation, including any relevant dates:

How would you rate your legal needs described here?

Are any other people involved?
Yes  No 

If yes, provide names, addresses (if known), and their relationship to you, if any:

Do you have any documents that could help explain your situation?
Yes  No 

If yes, list those documents and their dates:

Are there other documents that you do not have access to that could be of assistance?
Yes  No 

If yes, list those documents and their dates and locations (if known):

Describe how this situation has impacted you:

Describe what you would like to happen to resolve your issue (your preferred outcome):

Have other attorneys worked on this matter?
Yes  No 

If yes, provide names, addresses, and a brief description of their involvement:

Special concerns:

Where did you hear about this website?

The contents of this contact form are provided by and are the responsibility of the person posting the email communication. Your email will not create an attorney-client relationship and will not necessarily be treated as privileged or confidential. You acknowledge that any reliance on material in email communications is at your own risk.

Because You Have a Choice…

The Law Firm of Pugh, Barrett, Canale & Leslie LLC
Attorneys at Law
Phone: 770.424.8381
E-Mail

The Law Firm of
Pugh, Barrett, Canale & Leslie LLC
288 Lawrence Street NE
Marietta, GA 30060

Phone: 770.424.8381
Fax: 770.427.2384

Email Us | Get Directions

The Law Firm of Pugh, Barrett, Canale & Leslie LLC is located in Marietta, Georgia, and our attorneys service the Marietta-Atlanta area, including the cities of Marietta, Atlanta, Smyrna, Roswell, Kennesaw, Powder Springs, Austell, College Park, Acworth, Woodstock, Alpharetta, Norcross, Hiram, Canton, Holly Springs, Cumming, Cartersville, Dallas, and Mableton. Our lawyers also represent clients throughout the communities in and around Cobb County, Paulding County, Douglas County, Cherokee County, Bartow County, Forsyth County, Fulton County, De Kalb County, Gwinnett County, and Pickens County.