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Criminal Defence Web Intake Form

Name *

Date of Birth

Cell Phone *

Home Phone

Work Phone

Email Address *

Street Address

City *

Province

Postal Code

Are you a Canadian Citizen Yes No

If you are contacting us on behalf of someone else, please provide that person’s full name, date of birth and your relationship to that person

Please describe the criminal charge(s) *

When were you arrested and charged? *

When is your next court date?

What is the location of the court for your next court date, eg. Belleville? *

What is the police service that laid the charge?

Do you know the name of the complainant? If yes, please provide the name.

Is there a co-accused? If yes, please provide the name(s) of the co-accused persons.

Is this a private retainer or Legal Aid? Private Retainer Legal Aid

If Legal Aid, have you applied? Yes No

If yes, do you have a Legal Aid certificate? If yes, please provide the certificate number.

Are you employed? Yes No

If yes, please describe your employment and your employer

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