Attorney Intake Form Invasion of Privacy

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Privacy is a more highly prized right the more technology intrudes into our lives. Sometimes, you may feel that your privacy has been violated, and in some instances, you may have legal rights against the person who invaded your privacy. This form can help you and your attorney determine whether your legal privacy rights have been injured and whether you can recover for that violation.

 Name: ____________________________________ Address: ____________________________________ ____________________________________ Telephone Number Work: ________________________ Home: ________________________ Employers Name: ____________________________________ Employers Address: ____________________________________ ____________________________________ ____________________________________ May we contact you at work? Yes _______ No _______ Why do you need legal advice about claims for invasions of privacy? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Section I: If You Think Your Privacy Has Been Invaded or Compromised 1. Somebody has intruded on my privacy by coming into or peering into my home, listening to my private conversations, calling me all the time on the telephone, going through my things, or something similar. Yes _______ No _______ 2. If the intrusion did not happen at your home, were you in a public place? Yes _______ No _______ 3. Where were you? _____________________________________________________ 4. Please provide a brief description of what has happened. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 5. Somebody has revealed something private or embarrassing about me that should have been kept confidential. Yes _______ No _______ 6. Was the disclosure made public? Yes _______ No _______ 7. If you answered Yes to question 6, please describe how and where the disclosure was made public. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 8. Please describe what was disclosed or the nature of the disclosure. A general description, like revealed my medical records, or revealed something about my past is perfectly fine at this point. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 9. Somebody has done something that has conveyed a false impression about me to the public. Yes _______ No _______ 10. Please provide a brief description of what has happened. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 11. How, or in what way, did this act place you in a bad light to the public? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 12. Somebody has used my name or my likeness without my permission. Yes _______ No _______ 13. How is your name or likeness being used? ______________________________________________________________________________ ______________________________________________________________________________ 14. Did you give the person permission to use your name or likeness? Yes _______ No _______ 15. Did you withdraw that permission? Yes _______ No _______ 16. Has someone been impersonating you? Yes _______ No _______ 17. If you answered yes to question 16, what has that person been doing while pretending to be you? ______________________________________________________________________________ ______________________________________________________________________________ 18. Is the person using your name or likeness using it to his or her own profit or advantage? Yes _______ No _______ 18. How long ago did the incident(s) occur? In the last year _______ More than one year ago _______ More than two years ago _______ More than three years ago _______ 18. If you know the precise date, please write it here: _______________________________ Section II: If You Are Being Sued  1. Somebody has accused me of going into or peering into his or her home, eavesdropping, making prank or hang-up calls, going through his or her things, or something similar. Yes _______ No _______ 2. Did the alleged invasion occur in a public place? Yes _______ No _______ 3. Where were you? _____________________________________________________ 4. Please provide a brief description of what the accusation is. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 5. Somebody has accused me of revealing something private or embarrassing that should have been kept confidential. Yes _______ No _______ 6. If you did in fact reveal something, what were the circumstances, who did you reveal it to, and why? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 7. Was the disclosure made public? Yes _______ No _______ 8. Please describe what you are accused of disclosing. A general description, like revealed confidential records, or revealed something about the plaintiffs past is perfectly fine at this point. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 9. Somebody has accused me of doing something that has conveyed a false impression about him or her to the public. Yes _______ No _______ 10. Please provide a brief description of what has happened. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 11. Somebody has accused me of using his or her name or likeness without permission. Yes _______ No _______ 12. In what way does the plaintiff contend you are using his or her name or likeness? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 13. Did you have, or once have, the plaintiffs permission to use his or her name or license? Yes _______ No _______ 14. If you had permission, was it withdrawn? Yes _______ No ________ 15. Please explain your answer to question 14. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 16. Someone has accused me of impersonating him or her. Yes _______ No _______ 17. If you answered yes to question 16, what does the plaintiff contend you have being doing during the impersonation? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 18. If you have been using the plaintiffs name or likeness, has there been any profit or advantage to you? Yes _______ No _______ 19. How long ago did the incident(s) occur? In the last year _______ More than one year ago _______ More than two years ago _______ More than three years ago _______ 20. If you know the precise date, please write it here: _______________________________ 21. Do you have liability insurance? Yes _______ No/Not Sure _______ If you do have liability insurance, please take a copy of it, along with any amendments or riders to it, with you to the first meeting with your attorney.