Bankruptcy Questionnaire Template
A free bankruptcy questionnaire for consumer bankruptcy lawyers. Clients share debts, income and urgent threats, and lead mode marks urgent cases as hot.
Customize the pages and design to fit your needs.
About this template
Collect each inquiry's total debt, the kinds of debt, income, home ownership and any foreclosure, garnishment or lawsuit already underway. Lead mode marks people facing urgent collection action as hot leads so you call them first.
Common uses
- Consumer bankruptcy firms
- Chapter 7 and Chapter 13 inquiries
- Debt relief ad landing pages
Key features
- Debt, income and assets
- Urgent foreclosure and garnishment flags
- Hot leads for urgent collection action
What this template asks
What's your full name?
Short Text
What's your email address?
Email
What's your phone number?
Phone
Which county and state do you live in?
Short Text
Who would be filing?
Single Choice · Just me, Me and my spouse
Roughly how much do you owe in total?
Single Choice · Under $10,000, $10,000 to $50,000, $50,000 to $100,000, Over $100,000, Not sure
Which kinds of debt do you have?
Multiple Choice · Credit cards, Medical bills, Personal loans, Car loan, Mortgage, Student loans, Back taxes, Business debt
Is any of this happening right now?
Multiple Choice · Foreclosure on my home, Wages being garnished, Car repossession, A creditor is suing me, Collection calls, None of these
What's your work situation?
Single Choice · Employed full time, Employed part time, Self employed, Retired or on disability, Not working
Do you own a home?
Yes / No
Have you filed for bankruptcy before?
Yes / No
Do you already have a lawyer for this?
Yes / No
Anything else we should know?
Long Text · Optional
When is the best time to call you?
Single Choice · Morning, Afternoon, Evening
How to use this template
Copy it
Select Use template and a copy opens in your workspace as an unpublished draft.
Make it yours
Edit any question or answer, choose a theme, and add your logo.
Share it
Publish, then send the link, show a QR code, or embed the form on your site. Responses arrive in Submissions.
Frequently asked questions
What does a bankruptcy intake form ask?
Total debt, the kinds of debt, income, home ownership, past filings and any foreclosure, garnishment or lawsuit already underway. It's enough to plan the first consultation.
Which inquiries does lead mode mark as hot?
People with more than $10,000 in debt who face foreclosure, garnishment, repossession or a lawsuit, and who don't have a lawyer yet.
Can I collect the full bankruptcy questionnaire later?
Yes. Use this form to screen inquiries, then send a longer questionnaire with document uploads once the client hires you.