Immigration Intake Questionnaire | The Law Offices of Peter Loblack
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Immigration Intake Questionnaire

 
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WHO ARE YOU SEEKING LEGAL ADVICE ABOUT?

(i.e. who wants the visa, was denied, is in removal, etc)?

Please fill out the questionnaire concerning your own situation or problems OR If you are making inquiries about another person’s case or problems (i.e. your friend or relative), please provide information about the person you are inquiring for, NOT ABOUT YOURSELF (i.e. pretend you are the person on whose behalf you are making the inquiry, and answer as though he/she was filling out the question himself/herself).
  • PLEASE DO NOT WRITE/PRINT ON BACK OF PAGES
  • NO PERSONAL CHECKS are accepted for Initial Consultations. (In person consultation fee can be paid in Cash, Money Order, Cashier’s Check, or via Online Payment/PayPal.)
  • It is important to the evaluation of the case that you complete this Questionnaire accurately, truthfully and completely. We assure you that the information supplied by you (whether or not you retain our services) is strictly confidential.
  • PLEASE PRINT LEGIBLY, USING BLUE or BLACK INK.
  • If filling out online, you must check "certification box" at end of questionnaire.
INFORMATION ABOUT PERSON WITH IMMIGRATION PROBLEM (“CLIENT”)
Client’s Full Name

(Exactly as it appears on the birth certificate):

Name Client is currently using:
Other names used

(Maiden, Married, Religious, Professional, Assumed, Aliases):

Did client enter the U.S. under an “assumed or fake name”?
Client’s Present Address
Client’s Contact Information
Alternate contact person for client in U.S. in case client cannot be reached:

(Should be different from client’s contact info.)

Client’s Date of Birth:
Client’s Birthplace
Client’s Marital Status
(whether Church, civil, or “secret” marriage)?
Marital History
Marriage