Invasion of Privacy Claim: Attorney Intake Form
Created by FindLaw's team of legal writers and editors | Last reviewed June 20, 2016
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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.
Attorney Intake Form: Invasion of Privacy
Name: _________________________________
Address: _______________________________
_______________________________________
Telephone Number Work: _________________________
Home: _______________________
Employer’s Name: _______________________________
Employer’s 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?
__________________________________________________________________________
__________________________________________________________________________
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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 _______
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: ______________________________
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 plaintiff’s 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 plaintiff’s 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 plaintiff’s 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.
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