Client Intake Questionnaire

CLI-Minnesota | 3300 Edinborough Way, Suite 550 | Edina, Minnesota 55435
Tel: 952.405.2010 | Fax: 952.405.2011 | E-mail:

Name
Address, City, State, Zip
Phone Number ^*
Email address (if applicable)
Number of children under 18 (if any)
What is your annual gross income?
Your Husband/Wife’s annual gross income?
Tell us a little bit more about the specifics of your case

^{* Where you can safely be reached}