239.434.2294 blb@bainlawfirm.com

New Client

Please complete the form below if you would like to speak with someone from our office to schedule a consultation.  The initial consultation can take place at our office or via conference call, whichever is most convenient for you.

The Bain Law Firm P.L.
Initial Client Consultation Interview Form
The purpose of an initial consultation is for the interviewing Attorney to advise you, the prospective client, what if anything, may be done for you by our law firm, and what the minimum fee for our services will be. The purpose is not to render a definitive legal opionion as it may be impossible to fully assess a matter within the time frame allotted for a consultation or with the information or documents that you may be able to provide at the initial consultation. Any expression by the interviewing Attorney concerning your legal matter is an expression of professional judgment, but is not a guarantee. Such opinions are necessarily limited by our knowledge of the facts provided to us and are based on the state of the law at the time they are expressed.
One of three outcomes is possible following your consultation:
A. You and this law firm mutually agree to the terms of representation, (After a separate initial letter of representation is signed by you which encloses and incorporates by reference a separate document called “Standard Conditions Regarding Legal Representation” which will be provided to you and sets forth the terms of our representation.), or
B. This law firm declines representation, or
C. You decide not to use the services of this law firm.

Your Name

Address, City, State, Zip Code

Work Telephone (with area code)

Home Telephone (with area code)

Fax (with area code)

Cell (with area code)


Briefly explain what you need advice about or assistance with today.

Are there other parties involved? (Examples: a friend, an employer, a neighbor, a party to a contract, etc. This should include all individuals and parties on either side of your issue.)
Party and Relationship 1
Party and Relationship 2
Party and Relationship 3

List the documents (papers) that you think may help us to understand the issues.

Ideally, if things turn out precisely the way you want, what would the outcome be?

Knowing that there are no guarantees, what can you accept to resolve this matter?

Please classify your urgency in concluding this matter. (check one)

If the matter involves payment to you of money you believe you are owed, how long can you wait before being paid?

Have you ever been represented by an attorney?
If yes, please state the circumstances.

Are you currently a party to a lawsuit or other legal proceedings?
If yes, please identify the lawsuit and legal proceedings, and nature of the issues.

Have you ever been party to a legal proceeding, such as a lawsuit, criminal action, administrative action, bankruptcy action, or arbitration proceeding?
If yes, please identify all such legal proceedings, including approximate dates and locations.

Please list other names that you may be known by (a fictitious name, nickname, former name, maiden name, etc...)

Have you ever been convicted of a crime?
If yes, please describe the crime, as well as the date and location of conviction.

How will you pay for your attorney's fees and costs in connection with this matter?

Marital Status

Where are you employed?

May we contact you at your place of employment?
If yes, please provide a telephone number (including area code).

If your mail is returned as undeliverable or your phone service terminated, please provide the name of someone who will always know how to contact you (list name, address and phone number)

If referred to us, please identify the individual who referred you.


Following your initial interview, if you agree to hire this law firm, and this law firm agrees to represent you, you will be required to sign an initial letter of representation which will be provided to you by the interviewing Attorney after your meeting along with a document entitled "Standard Conditions Regarding Legal Representation". The initial letter of representation and our "Standard Conditions Regarding Legal Representation" will set forth the terms and conditions of our representation.

If the interviewing Attorney indicates that this law firm is willing to represent you and you decide not to sign the initial letter of representation, you are strongly urged to immediately consult with other legal counsel to protect your rights.

NOTICE: This law firm does not represent you with regard to the matters set forth by you in this information sheet or discussed during your consultation with the interviewing Attorney, unless and until, this law firm agrees to represent you and you have signed and returned our written agreement for representation which is embodied in our initial letter of representation (which incorporates and includes the terms and conditions set forth in the "Standard Conditions Regarding Legal Representation").

If the interviewing Attorney indicates that this law firm will not represent you, this includes not representing you with regards to the matters set forth by you on this information sheet as well as any other matters you may discuss with the interviewing Attorney during your consultation. Please realize that there are strict time limitations within which you must act in order to protect your rights. The time limits are complex and vary for different types of legal actions. Failure to file a lawsuit or claim within the requisite time could result in you being barred forever from pursuing your claims. Furthermore, failure to defend a legal action (i.e., lawsuit, etc.) or act within the requisite time could result in an adverse judgment against you or you being barred in the future from defending or asserting your rights. Therefore, the interviewing Attorney and this law firm strongly urge you to immediately consult with another attorney to protect your rights. The decision by the interviewing Attorney or this law firm not to represent you should not be taken by you as an expression regarding the merits of your case. We are not expressing an opinion as to whether or not you should take further legal action with regard to your legal matters. Our decision to decline representation merely indicates only that we will not be representing you with respect to such legal matters.

Your signature below acknowledges only that you received a copy of this completed information sheet and does not mean that you have hired the interviewing Attorney or the law firm to represent you.

Signature (type your full name) (required)

Today's Date (required)