Call 24/7 | 888.327.4652

Contact Us

Confidential Attorney-Client Communication

Shouse Law Group
(888) 327-4652
fax: (310) 860-5600
inquiry@shouselaw.com

CLIENT INTERVIEW FORM

Please provide as much information as possible. Note: Fields with a * are required.

* Name

Date

Address

(Number, street, city, and zip code)

Telephone:

(Home)
(Work)
(Cell)

Birthdate

- -

Social Security No.

- -

How Did You Learn About Our Practice?

If Other

* Email Address

TELL US WHAT HAPPENED:

Date of Arrest or Police Contact

Time of Arrest or Police Contact

Location of Arrest or Police Contact

THE ARREST: SEARCHES; STATEMENTS TO POLICE: Did anything unusual happen when you were arrested? Were you, anyone with you, or any place searched? Did the police take anything? Did you make a statement to the police?

Next Court Date

Location of Next Court Date

Education

(Highest grade
completed)

(School name)

Vocational Training

(Skill)

(School name)

Driver's License No.

Auto Model/Make

Automobile License No.

Do you have any outstanding warrants for your arrest? Please give the details.

Is English your native language? If not, what is? Do you need an interpreter?
Are you a U.S. citizen? If not, what are your immigration status and the date of your most recent entry into the U.S.?

Do you have another case pending?

Are you now on probation or parole?

If you are on probation or parole, please list the officer or agent's name, address and telephone number.

Have you informed your probation officer or parole agent about this current charge(s)?

List all prior arrests and whether convicted or not.

Offense
Arresting Agency
Date
Disposition (What Happened)

Offense
Arresting Agency
Date
Disposition (What Happened)

Offense
Arresting Agency
Date
Disposition (What Happened)

Offense
Arresting Agency
Date
Disposition (What Happened)

Offense
Arresting Agency
Date
Disposition (What Happened)

FAMILY

Father
Name
Address
Telephone
Birthdate
Where Employed

Mother (Maiden)
Name
Address
Telephone
Birthdate
Where Employed

Children/Stepchildren
Name
Address
Telephone
Birthdate
Where Employed

Name
Address
Telephone
Birthdate
Where Employed

Name
Address
Telephone
Birthdate
Where Employed

Name
Address
Telephone
Birthdate
Where Employed

Name
Address
Telephone
Birthdate
Where Employed

MARITAL HISTORY

Married to:	Date Married	Date Separated/Divorced

EMPLOYMENT HISTORY (List present or last employment first)

From/To
Name of Employer
Type of Business
(Position Held)
(Address)
(Telephone)

From/To
Name of Employer
Type of Business
(Position Held)
(Address)
(Telephone)

PLEASE DESCRIBE ANY CHURCH, CHARITY, CIVIC & COMMUNITY SERVICE INVOLVEMENT

LIST PERSONAL REFERENCES WITH COMPLETE MAILING ADDRESSES (Persons who know you other than relatives)

Name
Address
Telephone

Name
Address
Telephone

Name
Address
Telephone

Name
Address
Telephone

PHYSICAL, MENTAL, EMOTIONAL, MARITAL, DRUGS, AND/OR ALCOHOL PROBLEMS:
Do you have a problem in any of the above areas that has something to do with your case?
Yes No

If yes, please explain:

Are you currently under treatment or seeing a counselor?
Yes No

Name
Telephone

WITNESSES: Please list all the names, addresses, and telephone numbers of people who witnessed the alleged crime or who can give information about it.

Name	Address	Phone

(Date)

(Signature of client)

If someone helped you to complete this questionnaire, please write his or her name, address, and telephone number below.

(Name)

(Address)

(Telephone)

Anti-spam question:

California Criminal Law Explained.....

Call Us for Help | 888.327.4652

If you or a loved one faces misdemeanor or felony charges, contact our California criminal defense attorneys for help. We'd be glad to meet with you for a free consultation at one of our local criminal law offices in Los Angeles, San Francisco, Van Nuys, Pasadena, Long Beach, Orange County, Rancho Cucamonga, San Bernardino or Riverside.

Burbank Criminal Attorneys

Burbank Office:
3500 West Olive Ave.
3rd Floor
Burbank, CA 91505
(818) 904-5863

google map

Glendale Criminal Attorneys

Glendale Office:
450 North Brand
6th Floor
Glendale, CA 91203
(818) 904-5863

google map

Long Beach Criminal Attorneys

Long Beach Office:
444 West Ocean Blvd.
Suite 800
Long Beach, CA 90802
(562) 633-8155

google map

Los Angeles Criminal Attorneys

Los Angeles Office:
5670 Wilshire Blvd.
Suite 1350
Los Angeles, CA 90036
(310) 860-5605

google map

Newport Beach Criminal Attorneys

Newport Beach Office:
4590 MacArthur Blvd
5th Floor
Newport Beach, CA 92660
(949) 644-4692

google map

Pasadena Criminal Attorneys

Pasadena Office:
790 East Colorado Blvd.
9th Floor
Pasadena, CA 91101
(626) 345-0983

google map

Rancho Cucamonga Attorneys

Rancho Cucamonga Office:
3200 Guasti Road
Suite 100
Ontario, CA 91761
(909) 483-2814

google map

Riverside Criminal Attorneys

Riverside Office:
4480 Main Street
Riverside, CA 92501
(951) 734-5216

google map

San Bernardino Criminal Attorneys

San Bernardino Office:
198 N. Arrowhead Ave.
San Bernardino, CA 92408
(909) 863-5500

google map

San Francisco Criminal Attorneys

San Francisco Office:
101 California Street
Suite 2450
San Francisco CA 94111
(415) 333-0300

google map

Santa Ana Criminal Attorneys

Santa Ana Office:
500 North State College Blvd.
Suite 1100
Orange, CA 92868
(714) 288-9455

google map

Van Nuys Criminal Attorneys

Van Nuys Office:
15303 Ventura Boulevard
9th Floor
Sherman Oaks, CA 91403
(818) 904-5863

google map

Ventura Criminal Attorneys

Ventura Office:
2625 Townsgate Road
Suite 330
Westlake Village, CA 91361
(805) 648-1680

google map

If you'd like further assistance...

Join us to discuss your DUI case at any of our
local offices: You can also contact us 24/7 at
888.327.4652 for a free consultation

West Covina Criminal Attorneys

West Covina Office:
100 N. Barranca Ave
West Covina, CA 91791
(626) 345-0983

google map

Rancho Cucamonga Criminal Defense Attorney Disclaimer: The Felony, Misdemeanor and Traffic or Criminal Defense and Drunk Driving, DUI, DMV Drivers License Suspension, Theft, Drugs, 3 Strikes or Murder or other legal defense information presented at this site should not be considered formal legal advice nor the formation of a lawyer or attorney client relationship. Our criminal defense law firm serves the following communities, among others: Los Angeles County, California, Agoura, Alhambra, Bellflower, Beverly Hills, Burbank, Calabasas, Century City, Chatsworth, Compton, Culver City, Diamond Bar, Downey, El Segundo, Encino, Glendale, Glendora, Hermosa Beach, Hidden Hills, Hollywood, Huntington Park, Inglewood, Los Angeles Lawyer, La Canada, Long Beach, Los Angeles Attorney, Malibu, Manhattan Beach, Marina Del Rey, Norwalk, Palos Verdes, Pasadena, Pomona, Rancho Palos Verdes, Redondo Beach, Rolling Hills, San Dimas, San Fernando, San Marino, San Pedro, Santa Clarita, Sierra Madre, Santa Monica, South Gate, South Pasadena, Sylmar, Torrance, Universal City, Valencia, Van Nuys, West Covina, West Hollywood, Walnut, Westchester, Westlake Village, Whittier, Woodland Hills, California, Orange County Criminal Defense Attorney and DUI lawyer for Orange County; Attorney and DUI lawyer San Bernardino County, California, Ontario, Rancho Cucamonga, Fontana, Redlands, Upland, Riverside, Corona, Norco, Santa Barbara County, Santa Barbara.

© 2010 Shouse Law Group. All rights reserved. We employ Copyscape Premium. Any republishing of copyrighted material without the express written consent of the publisher is prohibited. Such plagiarism is illegal, constitutes professional misconduct and constitutes an infringement of the Digital Millennium Copyright Act.

Sitemap | Las Vegas Nevada Criminal Defense Lawyers | Español