Name: Immigration Law Office
Price range: $$

Name

This field is for validation purposes and should be left unchanged.

Date of your scheduled consultation

Reason for your consultation (what is your immigration goal/objective)*

Your name*

Date of birth:*

Town, State, and Country of Birth:*

Your phone*

Email*

Current address*

Street Address City State / Province / Region ZIP / Postal Code Country

What is your immigration status? (i.e. no status, student, work visa, etc.)*

When, where, and how did you enter the United States?*

i.e (date/place of entry/illegally/tourist visa, N/A...)

Marital status*

Single
Married (once)
Married (remarried)
Divorced
Widowed

is, or was your spouse a Legal Permanent Resident or a U.S. Citizen?*

Please provide your children's information (if any)

Name	Age	Country of birth	Country of Residence	Legal Status

Has your spouse or child ever served in the U.S. military?*

yes
no

Has anyone ever filed an application in the past on your behalf, or spouse/ex-spouse?**

If "yes" please upload proof of document

Have you, your spouse, or child(ren) ever been a crime victim in the U.S and did the police or a court was involved?*

yes
no

Have you ever been in deportation proceedings?*

Yes
No

(did you go to court in front of a judge)

If "yes", when and what was the end result of the case?

Have you ever been in contact with any immigration official/ICE?*

Yes
No

Have you ever helped, suggested, or brought anyone illegally to the U.S.?*

Yes
No

Have you ever falsely claimed to be a U.S. citizen?*

Yes
No

Have you ever been a victim of domestic violence by a spouse, parent, or child?*

Yes
No

Have you ever been arrested, received a ticket, or in jail for any reason? If yes, briefly state what, where, when did it happened and the outcome?*

How did you hear about our office/attorney?*

Document upload

Drop files here or

Accepted file types: jpg, png, jpeg, pdf, Max. file size: 128 MB.

Legal disclaimer - please read below*

I agree to the privacy policy.

PLEASE READ CAREFULLY

If the reason for your consultation appointment involves a deadline or you have an upcoming hearing, you are strongly encouraged to notify the Attorney of this in writing either by mail or email. If the Attorney cannot meet with you prior to your deadline or hearing, you should immediately consult with another attorney to protect your legal rights.

Following your consultation appointment, if you agree to retain the Attorney and the Attorney agrees to represent you, you will both sign an Agreement for Representation. The Agreement for Representation will set forth the terms and conditions of representation and the office legal fees for your particular matter.

We have the right to refuse our services to anyone. If the Attorney does not agree to represent you, you are advised to immediately consult with another attorney to protect your legal rights. This decision should not be taken as an expression regarding the merits of your case but only to the Attorney’s opinion on the case based on her experience in Immigration Law.

With your signature below you acknowledge that you have read and understand the contents of this Client Intake Form and/or that you have had the contents of this Intake explained to you in your native language. The information provided herein is true and correct to the best of your knowledge. In addition, you must provide any and all immigration/Criminal records (USCIS receipt notices, Request for Evidence letter, Visa Stamp, Passport Biographic page, etc) for the attorney’s review along with the submission of your Client Intake Form prior to your appointment to avoid any cancellations or rescheduling.

PLEASE NOTE: THIS OFFICE DOES NOT REPRESENT YOU WITH REGARD TO THE MATTERS SET FORTH HEREIN OR DISCUSSED DURING YOUR CONSULTATION APPOINTMENT UNLESS AND UNTIL BOTH YOU AND THE ATTORNEY EXECUTE A WRITTEN RETAINER AGREEMENT FOR REPRESENTATION. HOWEVER, YOUR DISCUSSION WILL STILL BE PROTECTED UNDER THE ATTORNEY-CLIENT PRIVILEGE AND WE WILL NOT DISCLOSE YOUR PERSONAL INFORMATION TO ANY THIRD PARTIES WITHOUT YOUR CONSENT OR TO IMMIGRATION OFFICIALS.

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Intake

CONSULTATION INTAKE