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Shouse Law Group
(888) 327-4652
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

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Glendale Criminal Attorneys

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

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Long Beach Criminal Attorneys

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

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Los Angeles Criminal Attorneys

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

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Newport Beach Criminal Attorneys

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

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Pasadena Criminal Attorneys

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

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Rancho Cucamonga Attorneys

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

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Riverside Criminal Attorneys

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

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San Bernardino Criminal Attorneys

San Bernardino Office:
432 N Arrowhead Ave
San Bernardino, CA 92401
(909) 863-5500

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San Francisco Criminal Attorneys

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

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Santa Ana Criminal Attorneys

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

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Van Nuys Criminal Attorneys

Van Nuys Office:
14500 Roscoe Blvd.
4th Floor
Van Nuys, CA 91402
(818) 904-5863

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Ventura Criminal Attorneys

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

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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

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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.

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