D.R. Roseen Attorney at Law, LLC O: +1 323 902 7779
931 Monroe Drive, NE Ste 102A-307 RoseenLaw.com
Atlanta, GA 30308 Support@RoseenLaw.com
Roseen Law | General Intake Form
This form is designed for individuals—not corporate entities—seeking legal representation. If you are seeking legal representation for your business, please complete our separate
Business Intake
form.
Thank you so much for contacting our law office! Please read the Privacy Policy below, and then fill out this form in its entirety prior to any consultation.
Note: Completion of this form does not create an attorney-client relationship. Representation begins only after a signed Engagement Agreement and Fee Arrangement.
Privacy Policy
All the information you provide our law firm as a prospective or current client is strictly confidential. Information collected is used only for evaluating potential representation and providing legal services, if retained.
Our firm takes every step possible to protect your privacy and the integrity of your information. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.
We collect personal information to verify your identity, run conflict-of-interest checks, and better understand your legal needs. Our firm will use your information in the event that you hire us to represent you in your legal matter, and then only when necessary in limited use during the course of your case.
Some other examples of how this information may be used include:
initial service,
in court orders,
in required reports or other documents filed with the State.
If you have any questions, please don't hesitate to contact our office and direct your inquiry to one of the following departments:
Intake: Intake@RoseenLaw.com
Technology Support: Tech@RoseenLaw.com
Billing: Billing@RoseenLaw.com
General Assistance: Support@RoseenLaw.com
We look forward to working with you!
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Please provide a brief description of your legal issue, why you are seeking legal support, any adverse or opposing parties, and relevant deadlines or court dates.
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Have you consulted with another attorney about this matter?
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ADMINISTRATION & E-ACKNOWLEDGEMENT
If our law firm ends up representing you in this matter, will you be the person who pays the legal fees?
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Our firm may be able to offer reduced, sliding scale, or alternative fee arrangements to clients who qualify based on factors such as income, employment status, or other demonstrated financial need. Successful applicants generally have an annual household income between 0-250% of Federal Poverty Guidelines. Availability of sliding scale fees is not guaranteed and depends on eligibility review and attorney availability. Would you like to receive an application to be considered for our sliding scale program?
Yes
Please provide an estimate of your average annual household income.
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We make every possible attempt to reach you prior to an emergency contact during true emergencies (e.g., medical incapacity, failure to respond to urgent deadlines). We protect confidential details, stating only we are your attorney and need to reach you.
ACKNOWLEDGEMENT AND ACCEPTANCE
I acknowledge that I have read and hereby accept the above Privacy Policy regarding use of my personal information. I understand that completion of this intake form does not guarantee representation. I further understand that an attorney-client relationship is formed only after a signed Engagement Agreement and Fee Arrangement, which must be completed at a later date.
Please type your full name to indicate your acknowledgment and acceptance:
THANK YOU
Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We will contact you as soon as possible with any updates.
Please click the
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