Home: Becoming a Client: Intake Form

If you are interested in becoming a client of our firm, please fill out this simple form. Please note that you will not become a client of Dozier, Miller, Pollard & Murphy until (1) we have reviewed the facts of your individual case, (2) decided to take your case, and (3) you have filled out and signed a client retainer agreement. Merely filling out this form does not automatically make you a client of our firm.

Tell Us Who You Are and How We Can Contact You.

First Name
Last Name
Address
City
State
Zip
E-mail (Required)
Day Phone
Night Phone
Fax

Please let us know what kind of assistance you require.

Please do not use this form to send confidential information.