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Client Intake Form: Once your Initial Consultation is scheduled, please complete and submit the form below. Be sure to do this in advance of your appointment time. The more information you provide, the better we will be able analyze the facts of your case and provide the best advice possible.  All the information you supply us will be kept STRICTLY CONFIDENTIAL and is protected by ATTORNEY-CLIENT PRIVILEGE.

CONTACT INFORMATION: Please provide the following contact information:

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
Cell Phone
Work Phone
E-mail

REFERRAL SOURCE: How were you referred to Glinsmann Immigration Lawyers? (choose one)

IDENTIFICATION: Please identify and describe yourself:

Date of Birth
Sex Male Female

MARITAL STATUS: Choose one of the following options:

CITIZENSHIP: Identify Your Country (Countries) of Citizenship

FAMILY TIES: Are any of your family members US Citizens or Lawful Permanent Residents ("Green Card Holders")? Select all that apply:

Mother/Father
Brother/Sister
Spouse
Fiancé
Child

CHILDREN: Do you have any children? (include natural, adopted and stepchildren)

Yes No

CHILDREN: If you answered yes to having children, tell us how many children you have:


EDUCATION: Indicate the highest level of education that you have completed :


LAST ENTRY: Which visa best describes your last entry to the United States?


I94 CARD EXPIRATION: If you have an I-94 Entry/Departure Card, when does the card expire?

DESCRIPTION OF MY CASE: Describe your case and list any questions you would like answered during the initial consultation:

 

   
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Revised: 06/03/10