## General Intake

Padilla Law General Intake

The survey will take approximately 4 minutes to complete.

Immersive Reader in Microsoft Forms allows you to hear the text of a form title and questions read out loud while following along. You can find the Immersive Reader button next to form title or questions after activating this control. You can also change the spacing of line and words to make them easier to read, highlight parts of speech and syllables, select single words or lines of words read aloud, and select language preferences.

When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.

1. What is your full legal name? Single line text.
2. What is your preferred title? Single choice.
   - Dr.
   - Mr.
   - Ms.
3. What is your phone number? Single line text.
4. What is your mailing address? (# Street, Unit, City, State Zip) Single line text.
5. What is your email? Single line text.
6. Are you representing a company? Single choice.
   - Yes
   - No

WARNING: Do not send or include any information if you consider the information confidential. By sending any information to us, you agree that the information does not create a lawyer-client relationship, and that any information is not confidential and not privileged.