Client Intake Form | Taheri and Todoro PC

Type of Case *
Court *
Client Information
First Name
Middle Initial
Last Name
Mailing Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Do you consent to receive legal information via email? *
Yes No
Phone Number * ### - ### - ####
Education
Grammar School
High School
Date of Graduation
College
Date of Graduation
Professional License
Do you have a professional License
yes no
If yes, please explain
Employment History
Present Employer *
Address
Start Date
Position/Duties
Spouse Employment (if applicable)
Present Employer
Address
Phone Number ### - ### - ####
Start Date
Position/Duties
Military Experience
Yes No
If yes, please explain
Medical Information
Please list any medications you are currently taking or
any medical history you think would be pertinent to your case/situation.
Do Not Fill This Out