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<header class="site-header">
  <div class="firm-name">Malikowski Law Offices, Ltd.<span>Nevada &amp; California &mdash; Since 1979</span></div>
  <div class="header-contact">
    <a href="tel:7757860758">(775) 786-0758</a> &nbsp;|&nbsp; Toll Free: <a href="tel:8665216919">(866) 521-6919</a><br>
    <a href="mailto:paul@nvlaw.com">paul@nvlaw.com</a> &nbsp;&middot;&nbsp; <a href="https://nvlaw.com">nvlaw.com</a>
  </div>
</header>
<div class="gold-rule"></div>

<div class="wrapper">
  <div id="form-container">
    <h1 class="page-title">New Client Intake</h1>
    <p class="page-subtitle">Confidential &amp; Protected by Attorney&ndash;Client Privilege</p>
    <div class="notice">
      <strong>Purpose of This Form</strong>
      The purpose of an initial consultation is for the attorney to advise you what, if anything, may be done for you and what the minimum fee therefor will be. Following your consultation, one of three outcomes is possible: (A) you and the attorney mutually agree to terms of representation; (B) the attorney declines representation; or (C) you decide not to use the attorney's services. Completion of this form does not establish an attorney-client relationship.
    </div>
    <div class="progress-wrap">
      <div class="prog-label"><span id="ptxt">Step 1 of 5</span><span id="ppct">0%</span></div>
      <div class="prog-track"><div class="prog-fill" id="pfill"></div></div>
    </div>

    <!-- STEP 1 -->
    <div class="step active" id="step-1">
      <div class="step-head"><span class="step-num">Step 1 of 5</span>Your Contact Information</div>
      <div class="fg">
        <div class="row3">
          <div class="f"><label>Last Name</label><input type="text" id="last" placeholder="Smith"></div>
          <div class="f"><label>First Name</label><input type="text" id="first" placeholder="John"></div>
          <div class="f"><label>Middle/Maiden</label><input type="text" id="middle" placeholder="Optional"></div>
        </div>
        <div class="row">
          <div class="f"><label>Best Phone</label><input type="tel" id="phone" placeholder="(775) 000-0000"></div>
          <div class="f"><label>Email</label><input type="email" id="email" placeholder="you@example.com"></div>
        </div>
        <div class="f"><label>Street Address</label><input type="text" id="address" placeholder="123 Main Street"></div>
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          <div class="f"><label>City</label><input type="text" id="city" placeholder="Reno"></div>
          <div class="f"><label>State</label><select id="state"><option value="NV" selected>Nevada</option><option value="CA">California</option><option value="Other">Other</option></select></div>
          <div class="f"><label>ZIP</label><input type="text" id="zip" placeholder="89501"></div>
        </div>
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          <div class="f"><label>Marital Status</label><select id="marital"><option value="">-- Select --</option><option>Married</option><option>Single</option><option>Divorced</option><option>Widowed</option><option>Separated</option></select></div>
          <div class="f"><label>How Did You Hear of Us?</label><select id="referral"><option value="">-- Select --</option><option>A Friend or Colleague</option><option>Former Client</option><option>Our Website (nvlaw.com)</option><option>Google Search</option><option>Bar Referral</option><option>Other</option></select></div>
        </div>
        <div class="f"><label>Other Names You Are Known By</label><input type="text" id="other-names" placeholder="Leave blank if none"></div>
      </div>
      <div class="nav"><span></span><button class="btn btn-next" id="n1">Continue &rarr;</button></div>
    </div>

    <!-- STEP 2 -->
    <div class="step" id="step-2">
      <div class="step-head"><span class="step-num">Step 2 of 5</span>Your Legal Matter</div>
      <div class="fg">
        <div class="f">
          <label>Practice Area</label>
          <select id="area">
            <option value="">-- Select the area closest to your matter --</option>
            <option>Real Estate (purchase, sale, lease, deed, foreclosure, landlord-tenant, HOA, lien)</option>
            <option>Estate Planning (will, trust, power of attorney, advance directive)</option>
            <option>Probate / Estate Administration (deceased person's estate)</option>
            <option>Business / Contracts (entity formation, operating agreement, commercial contract)</option>
            <option>Civil Litigation (lawsuit, collections, dispute resolution)</option>
            <option>Other / Not Sure</option>
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        <div class="f"><label>Describe What You Need Help With</label><textarea id="desc" rows="5" placeholder="Please describe your situation in your own words."></textarea></div>
        <div class="f"><label>Documents You Can Bring or Send</label><textarea id="docs" rows="3" placeholder="e.g., deed, contract, will, court papers..."></textarea></div>
        <div class="f"><label>Ideal Outcome</label><textarea id="ideal" rows="3" placeholder="If things turn out precisely as you hope, what would that look like?"></textarea></div>
        <div class="f"><label>Acceptable Outcome</label><textarea id="accept" rows="3" placeholder="Knowing there are no guarantees, what could you accept?"></textarea></div>
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      <div class="nav"><button class="btn btn-back" id="b2">&larr; Back</button><button class="btn btn-next" id="n2">Continue &rarr;</button></div>
    </div>

    <!-- STEP 3 -->
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      <div class="step-head"><span class="step-num">Step 3 of 5</span>Urgency</div>
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          <label>Urgency</label>
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            <label class="opt"><input type="radio" name="urg" value="Critical"><span class="opt-txt"><strong>Critical</strong> &mdash; Personal safety or continuation of business depends on it</span></label>
            <label class="opt"><input type="radio" name="urg" value="Very Important"><span class="opt-txt"><strong>Very Important</strong> &mdash; Severe hardship if not resolved quickly</span></label>
            <label class="opt"><input type="radio" name="urg" value="Important"><span class="opt-txt"><strong>Important</strong> &mdash; Interferes with business or personal financial stability</span></label>
            <label class="opt"><input type="radio" name="urg" value="No Immediate Hardship"><span class="opt-txt"><strong>Needs to be done</strong> &mdash; No immediate hardship in the interim</span></label>
            <label class="opt"><input type="radio" name="urg" value="Exploratory"><span class="opt-txt"><strong>Exploratory</strong> &mdash; Just wanted to know what my rights are</span></label>
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      </div>
      <div class="nav"><button class="btn btn-back" id="b3">&larr; Back</button><button class="btn btn-next" id="n3">Continue &rarr;</button></div>
    </div>

    <!-- STEP 4 -->
    <div class="step" id="step-4">
      <div class="step-head"><span class="step-num">Step 4 of 5</span>Prior Counsel &amp; Payment</div>
      <div class="fg">
        <div class="f">
          <label>Are We the First Attorneys You Have Consulted?</label>
          <div class="opts" id="fa-opts">
            <label class="opt"><input type="radio" name="fa" value="Yes"><span class="opt-txt">Yes &mdash; this is my first consultation</span></label>
            <label class="opt"><input type="radio" name="fa" value="No"><span class="opt-txt">No &mdash; I have consulted with other attorneys</span></label>
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        <div class="f" id="pr-wrap" style="display:none"><label>Why Didn't You Hire the Other Attorney(s)?</label><textarea id="pr-reason" rows="3"></textarea></div>
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          <label>How Do You Anticipate Paying?</label>
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            <label class="opt"><input type="radio" name="pay" value="On Account"><span class="opt-txt">On Account / Payment Plan</span></label>
            <label class="opt"><input type="radio" name="pay" value="Not Sure"><span class="opt-txt">Not Sure &mdash; I'd like to discuss</span></label>
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        </div>
        <div class="f"><label>Employment</label><input type="text" id="employer" placeholder="Employer name and city"></div>
      </div>
      <div class="nav"><button class="btn btn-back" id="b4">&larr; Back</button><button class="btn btn-next" id="n4">Continue &rarr;</button></div>
    </div>

    <!-- STEP 5 -->
    <div class="step" id="step-5">
      <div class="step-head"><span class="step-num">Step 5 of 5</span>Emergency Contact &amp; Acknowledgment</div>
      <div class="fg">
        <div class="row">
          <div class="f"><label>Emergency Contact Name</label><input type="text" id="ec-name" placeholder="Friend or family member"></div>
          <div class="f"><label>Relationship</label><input type="text" id="ec-rel" placeholder="e.g., sister, friend"></div>
        </div>
        <div class="row">
          <div class="f"><label>Emergency Contact Phone</label><input type="tel" id="ec-phone" placeholder="(775) 000-0000"></div>
          <div class="f"><label>Emergency Contact Address</label><input type="text" id="ec-addr" placeholder="City, State"></div>
        </div>
        <div class="f"><label>Additional Notes</label><textarea id="notes" rows="4" placeholder="Anything else you'd like us to know..."></textarea></div>
        <div style="border:1px solid var(--rule);background:white;padding:18px 22px;margin-top:6px">
          <p style="font-size:.79rem;color:var(--muted);line-height:1.8">
            <strong style="color:var(--ink);font-family:'Cormorant Garamond',serif;font-size:1.05em;display:block;margin-bottom:5px">Notice Regarding Representation</strong>
            This office does not represent you with regard to the matters set forth herein unless and until both you and the attorney execute a written Agreement for Representation. Completion of this form does not establish an attorney-client relationship.
          </p>
        </div>
        <div class="f" style="margin-top:18px">
          <label class="opt" id="ack-lbl"><input type="checkbox" id="ack"><span class="opt-txt">I have read the notice above and understand that submitting this form does not establish an attorney-client relationship.</span></label>
          <div class="err-msg" id="ack-err" style="display:none">You must acknowledge the notice to submit.</div>
        </div>
      </div>
      <div class="nav"><button class="btn btn-back" id="b5">&larr; Back</button><button class="btn btn-sub" id="sub-btn">Submit Intake Form</button></div>
    </div>

  </div>

  <div id="confirmation">
    <div class="ci"><svg width="26" height="26" viewBox="0 0 24 24" fill="none" stroke-width="2.5" stroke-linecap="round" stroke-linejoin="round"><polyline points="20 6 9 17 4 12"></polyline></svg></div>
    <h2 class="ct">Thank You &mdash; Form Received</h2>
    <p class="cp">Your intake information has been submitted to Malikowski Law Offices, Ltd. Paul will review your matter personally and be in touch to schedule your consultation.</p>
    <div class="cc" style="max-width:520px;margin:0 auto 24px">
      <strong style="color:var(--ink);font-family:'Cormorant Garamond',serif;font-size:1.05em;display:block;margin-bottom:6px">Please Respond Promptly</strong>
      To ensure your matter receives timely attention, please respond to any communication from this office by <strong id="confirm-deadline" style="color:var(--ink)">[date]</strong>. If we do not hear from you by that date, we will assume that you have engaged other counsel, that you have decided to proceed on your own, or that you have decided to drop the matter. Paul J. Malikowski retains sole discretion regarding whether to extend this period.
    </div>
    <div class="cc">
      <strong>Malikowski Law Offices, Ltd.</strong>
      4747 Caughlin Pkwy, Suite 7 &middot; Reno, NV 89519<br>
      (775) 786-0758 &middot; Toll Free (866) 521-6919<br>
      <a href="mailto:paul@nvlaw.com" style="color:var(--gold)">paul@nvlaw.com</a> &middot; nvlaw.com<br>
      <em style="font-size:.9em">Nevada &amp; California &middot; Licensed Since 1979</em>
    </div>
  </div>
</div>

<div class="gold-rule"></div>
<footer class="site-footer">&copy; Malikowski Law Offices, Ltd. &middot; <a href="https://nvlaw.com">nvlaw.com</a> &middot; Reno, Nevada &middot; (775) 786-0758</footer>

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    var deadline = fmtDeadline(addBizDays(new Date(), 5));
    g('confirm-deadline').textContent = deadline;
    var d=collect();
    fetch(FORMSPREE,{
      method:'POST',
      headers:{'Accept':'application/json','Content-Type':'application/json'},
      body:JSON.stringify({_subject:'New Client Intake: '+d.name, _replyto:d.email||'', message:buildMsg(d)})
    })
    .then(function(res){ return res.json(); })
    .then(function(data){
      if(data.ok){
        g('form-container').style.display='none';
        g('confirmation').style.display='block';
        window.scrollTo(0,0);
      } else {
        btn.disabled=false;
        btn.innerHTML='Submit Intake Form';
        alert('There was a problem submitting the form. Please try again or call the office directly.');
      }
    })
    .catch(function(){
      btn.disabled=false;
      btn.innerHTML='Submit Intake Form';
      alert('There was a problem submitting the form. Please try again or call the office directly.');
    });
  });

})();
</script>
</body>
</html>