Law Offices of Kendra L. Rimbert

Kendra L. Rimbert, Attorney at Law

2305 Hurstbourne Village Drive, Suite 1000, Louisville, KY 40299 · Mailing: PO BOX 91498, Louisville, KY 40291
Office (502) 614-4096 · Fax (502) 582-2864

General Client Request Form

3-Page Branded Intake

Client & Matter Information

Full Legal Name

Preferred Name

Date of Birth

Primary Telephone

Email Address

Current Address

Matter / Case Number (if known)

Date of Intake

Referral Source

Prior Attorney?yesno

Companion Case?yesno

Communication Preferences

How may the office reach you, and who else may we contact?

Other Communication Preference

Best Time to Reach You

Alternate / Emergency Contact Name

Relationship

Alternate Contact Telephone

May we contact this person re: administrative matters?yesno

Client Initials

Request Details

Check all that apply to your legal matter.

Other Matter Type

Date of Incident

Location of Incident

Opposing Party (if known)

Police / Report Number

Brief Description of the Matter

Client Notes & Questions

Use this space for any additional notes, questions, or information for the office

Electronic Acknowledgment

I certify that the information provided in this form is true and accurate to the best of my knowledge. I understand this information will be used by the Law Offices of Kendra L. Rimbert to evaluate my legal matter, and that this electronic submission constitutes my acknowledgment. I understand that providing this information does not by itself create an attorney-client relationship until a separate written agreement is signed.

Electronic Signature (type full name)

Signature Date

Final Acknowledgment Signature

Acknowledgment Date

For Office Use Only

Law-office-only review section — completed by firm staff.

Reviewer Name

Review Date

Assigned Attorney

Review Status

Office Notes