For Internal Use
Meeting Date:	Enter Date
Client Name:	Enter Client Name
Client Matter Code:	Enter Matter Code
Attorneys Assigned on File:	Enter Atty
Assistant Assigned to File:	Enter Assistant
Retainer Amt:	$Enter Amount
Attorney to Sign Retainer:	Choose Atty
Estimate:	$Enter Amount
Description of Services: Enter Description

Prospective Client Intake Sheet

Welcome to Burke & Casserly, P.C.

Thank you for considering Burke & Casserly, P.C. for your planning needs. In the event you should decide to retain Burke & Casserly, P.C. to represent you in your legal matters, we would appreciate you taking the time to provide us with the following information to ensure accuracy of our records.

Please check the box next to the column where you would prefer to be contacted.

We are so grateful for our referral sources and would like to extend our gratitude. Please indicate below how you heard about our firm (yellow pages, internet or word-of-mouth (and if so, by whom?))

Name of Client(s) (Person we would be representing) Enter Client Name	Primary Contact Person (if other than client) Enter Primary Contact Name
Client’s Home / Mailing Address and Phone Enter Street Address City, State Zip Enter Client Telephone Number(s)	Primary Contact’s Mailing Address and Phone Enter Primary Contact Street Address City, State Zip Enter Primary Contact Telephone Number(s)
Business Address and Phone (if applicable) Enter Business Street Address Enter Business Street Address Enter Business Telephone Number	Business Address and Phone (if applicable) Enter Business Street Address Enter Business Street Address Enter Business Telephone Number
Client’s Email Address(s) Enter Client Email Address Enter Client Alternate Email Address	Primary Contact Email Address(s) Enter Primary Contact Email Address Enter Primary Contact Alternate Email Address
How were you referred to us? (please specify name of person, internet, yellow pages, etc.) Enter Referral Source	Please indicate your preferred method of contact ☐ Telephone ☐ Email ☐ Cell phone

If you do not wish to be added to our email/mailing list please indicate by checking this box ☐