Consultation Form



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Free Consultation for Criminal Law
and Federal Defense

Use this simple form to provide us with information that will help us prepare for your free consultation. The information you are providing via this form shall be treated confidentially and is protected under the Attorney-Client privilege. Once received, we will phone you back at our earliest convenience.

Please note that this form is for criminal cases only, including those in Criminal Law and Federal Defense. Use these links for other types of cases:
NOTE: * indicates a required field.
Personal Information
First Last
Date of Birth (mm/dd/yyyy)
City, state, zip
(At least one phone number is required.
Use the format 555-555-5555.)
Work ext.
Case Information
Briefly explain what you may need advice about or assistance with.*
Do you have a court date?
Where is it and when?
Briefly explain any prior criminal record, arrests, convictions, dates and charges.
Which police department arrived?
Do you have any photos, reports, bills, estimates or any other documents?   Yes    No

If yes, please describe what you have.
Were you arrested?   Yes    No

If yes, please provide your booking number and name of the jail.
Amount of bail
Was bail paid? Yes  No
Were any recorded or written statements given or signed during this incident?   Yes    No

If yes, when and to whom?
Other Details
Are you completing this form on behalf of someone else?   Yes    No

If yes, please provide your contact information.
Your Name
First Last
Phone Number  ext.
Relationship to Subject
How would you pay for fees in this matter?
Credit Card
Cashier's Check/Money Order
Payment Plan
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Perez & Perez respects your privacy and does not sell or share your confidential information with any other parties. Read more about our privacy practices in our Privacy Policy.
The information provided at this web site by Perez & Perez, including all emails and newsletters, is not intended to be legal advice, and legal representation is subject to additional terms and conditions of a signed contract. To read more about this, please see our Legal Disclaimers.



1440 N. Harbor Blvd., Ste. 900, Fullerton, CA 92835, Phone: (714) 961-1966, Fax: (714) 961-1972

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