Client Intake Information Client Intake Information Client Intake Information Please complete and submit the information below. **Accurate information is the key to effective results**(Reply with NA if a required field does not apply) CLIENT NAME * First Name Last Name CLIENT ADDRESS * Address 1 Address 2 City State/Province Zip/Postal Code Country CLIENT EMAIL * CLIENT Phone (PRIMARY CONTACT) * (###) ### #### CLIENT VEHICLE and LICENSE PLATE * SUBJECT NAME and DESCRIPTION * First Name Last Name PICTURE OF SUBJECT * YES NO SUBJECT HOME ADDRESS * Address 1 Address 2 City State/Province Zip/Postal Code Country LIST SUBJECT SOCIAL MEDIA ACCOUNTS * SUBJECT VEHICLE and LICENSE PLATE * SUBJECT EMPLOYER and WORK ADDRESS * Address 1 Address 2 City State/Province Zip/Postal Code Country Is SUBJECT prone to anger or violence? * YES NO Does SUBJECT have a criminal history? * YES NO NOT SURE DOES SUBJECT CARRY A FIREARM? * YES NO NOT SURE Does the SUBJECT use illegal drugs? * YES NO NOT SURE OTHER PEOPLE (please list anyone living with SUBJECT) Pictures of SUBJECT'S associates? YES NO Preferred START Date * MM DD YYYY Brief description of the PURPOSE/NATURE of the investigation or service * Brief description of any SAFETY or SECURITY CONCERNS DESIRED RESULT * ANY additional information ACKNOWLEDGMENT * Client acknowledges that a non-refundable deposit of $500 is REQUIRED, and a Retainer and Services Agreement must be signed before any services will be provided. Yes No ACKNOWLEDGMENT * Client acknowledges that Miller Investigations, LLC, will take all safe and legal efforts possible to meet its clients' expectations, but Miller Investigations, LLC, will never guarantee, imply or insinuate a promise for a specific or general outcome. Yes No Thank you! We will review the information and contact you soon!
