Contact Our Nevada Criminal Defense Lawyers

Confidential Attorney-Client Communication

Las Vegas Criminal Defense Lawyers
702-DEFENSE (702-333-3673)
fax: 702-926-4345
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: