CLIENT INTAKE FORM

Let the Correll Law Firm, PLC build a strong case for you. Get started today.

Sending an email to an attorney will not establish an attorney/client relationship. Such a relationship is not typically established until an attorney knows that doing so will not create a conflict of interest and mutual agreement is reached on the terms of representation. Therefore, you should not send a message containing confidential or time-sensitive information.

Name *
Name
NOTICE: The Correll Law Firm, PLC values your privacy. Provide mailing address where ONLY the client (you) will receive CONFIDENTIAL attorney-client correspondence. By providing a mailing address below, you acknowledge that only you or your designee will read correspondence from the Correll Law Firm thereby protecting communications between you and the firm.
Date *
Date
Date of birth
Phone *
Phone
Best number to reach you
Street Address
Street Address
Your location
Mailing Address same as Street? *
Mailing Address
Mailing Address
Only if mailing address is different than above street address
Your employer if applicable - write N/A if not
Employer Address
Employer Address
Employer address if applicable
Category which best describes my case *
Select all that apply
How did you hear about Correll Firm? *

Let the Correll Law Firm, PLC build a strong case for you. Give us a call to set up an appointment.

The CORRELL LAW FIRm, PLC

10 West Boscawan Street
Suite 26
Winchester, VA 22601