Medgebow Law - Client Intake

Client Intake Form

Please select the type of legal matter you need assistance with. This helps us prepare the right questions for your case.

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Personal Injury

Accidents, slip & fall, negligence

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Criminal Defense

Charges, arrests, criminal matters

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Dog Bite

Dog attack or animal bite injuries

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Landlord / Tenant

Eviction, deposits, lease disputes

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Traffic Defense

Tickets, violations, license issues

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General / Other

Other legal matters

Client Intake Form

Please complete all fields as accurately as possible. All information is confidential and protected by attorney-client privilege.

Personal Information

First Name *

Last Name *

Date of Birth *

SSN (Last 4 digits)

Phone (with area code) *

Email Address *

Home Address *

County *

Incident Details

Witness Information

Were there any witnesses?

Insurance Information

Do you have relevant insurance?

Prior Legal Representation

Have you previously worked with an attorney on this matter?

Legal Network Membership

Do you have a legal plan through your employer or association?

Document Uploads

Upload any relevant documents such as police reports, medical records, photos, contracts, citations, etc. Accepted: PDF, JPG, PNG, DOC, DOCX (max 10MB each)

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Drag & drop files here or browse to upload

PDF, JPG, PNG, DOC, DOCX up to 10MB each

By submitting this form you confirm all information is accurate and complete.
All information is confidential · Medgebow Law, P.A.

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Intake Form Submitted!

Thank you! Your intake form has been securely submitted to Medgebow Law.

An attorney will review your information and be in touch with you shortly. If you need to reach us sooner, please call 954-478-4223 or email joel@medgebowlaw.com.