Confidentiality Notice: This form is held in strict confidence. Information collected here is used solely to assess how we can help you and prepare for your consultation. It will never be shared without your explicit written consent.
01Contact Information
02Your Situation
Please describe your situation in your own words. There are no wrong answers — the more context you provide, the better we can help.
03People Involved
04Digital & Technical Profile
05Safety Assessment
This section helps us understand the urgency of your situation and ensure we communicate with you safely. If you are in immediate danger, please contact emergency services first.
06Goals & Desired Outcomes
07Acknowledgment & Signature
By signing below, you acknowledge that this intake does not constitute legal advice, does not establish an attorney-client relationship, and does not guarantee services will be provided. All information is held in strict confidence.
Questions before your consultation? Reach out at astamenos@gmail.com or (917) 420-3695.