Criminal Defense Consultation Form
First Name:
Middle Name:
Last Name:
Date of Birth:	Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  Year:
Address:
Contact Number:
Home:
Cell:
Work:
E-mail address:
Are you currently employed?	----- Yes No
Are you or your relative currently in custody ?   ----- Yes No
If your attorney obtains bail for your release from custody, are you able to post bail ?   ----- Yes No
Are you a U.S. citizen ?   ----- Yes No
Are you a U.S. permanent resident ( Green Card holder) ?   ----- Yes No
Are you illegal in this country ?   ----- Yes No
Please describe your situation - 500 word maximum
Misdemeanor    Felony    Infraction
Past Criminal History - Please describe the crime, penal code, and sentencing dates (if any)
When is your next court hearing?
Where is your criminal case pending?
Are you currently on probation ?	----- Yes No