Intake Request Form

Email (required)

First Name (required)

Last Name (required)

Date of Birth (required)

Phone Number (required)

What is your legal issue? (required)
(If you do not see your legal issue below, most likely we do not handle that type of issue. If you have questions about whether or not your issue can be handled by our office, please call 478-238-0224.)

Please explain your legal issue in further detail. (required)

Please provide name and address, if known, of anyone that you think will be against you in your case? Adverse party. For example, if it is a divorce, list your spouse. If it is a guardianship, please list who you want guardianship over. (required)

County of Legal Issue: If your issue is outside the below counties, we cannot assist you. (required)
BibbCrawfordHoustonJonesMonroePeachTwiggs

Does your legal issue involve domestic violence against you or regarding you personally? If the domestic violence is documented, we cannot assist you. Please contact Crisis Line at 478-745-9292 or GA Legal Services at 833-457-7529.
YesNo

Your MONTHLY gross income Before Taxes. Please refer to the income guidelines on our website to make sure you qualify before submitting this form. (required)

Your spouse's MONTHLY gross income Before Taxes (required)

How many people are in your household? (required)