Client In-Take Form | The Powell Firm

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Full Legal Name

Birthday

Month

Day

Year

Address

Phone

Email

Arrest or Citation Details *

Were You Detained or Arrested? *

Detained

Arrested

Neither

Court Information*

Prior Criminal History*

Your Version of Events | Witnesses or Co-Defendants *

List names and contact information, if known:

1602 Washington Ave., Houston, Texas 77007

Tel: (281) 785-8850 / Fax: (713) 714-8670

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