Intake Form

Kindly ensure all mandatory fields are completed, as insufficient information could result in delays in addressing your concerns. By filling out and submitting this form, you grant us permission to collect your personal information. Rest assured, we maintain strict confidentiality when handling your details.

Name: *

First

Last

Home Address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What Jurisdiction Is This For?

Ontario
Nevada
Other
I don't know

Briefly Describe What You Need: *

Home Phone Number / Cell Phone Number: *

If We Call, Can We Leave Messages at the Above Number? *

Personal Email: *

Confirm Email

Is There a Court Case? *

Yes
No
Not Applicable

What Are the Names of the Other Parties Involved? *

Full name of the person or people involved in your case. If none, state "none." If unknown, state "unknown." If a business is involved, the name of the business.

How Did You Hear About Us?

Internet Search (i.e. Google)
Referral Service
Word of Mouth
Other

Did You Reach Us Through a Referral Service? *

Are You Contacting Us on Behalf of a Business? *

E-Signature Acknowledgement

With the e-signature below, I confirm that the information provided in this form is accurate to the best of my knowledge. By submitting this form, I authorize Grigoras Law to communicate via the above email address and phone number. I acknowledge that completing this form does not establish an attorney-client/lawyer-client relationship with Grigoras Law and that the firm is not yet retained to act for me or represent me. To become a client of Grigoras Law, the firm's usual policies for accepting clients require a mutually-executed retainer agreement.

E-Signature: *

Type your name in the box above to sign electronically and indicate your agreement with the E-Signature Acknowledgement.

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