# 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.

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.

Canonical: https://reuily.com/templates/bankruptcy-intake-form
Use this template: https://reuily.com/form/from-template/bankruptcy-intake-form
Collections: Marketing & Sales, Requests & Intake, Professional Services, Finance & Insurance, Legal
Last updated: 2026-10-25

## Questions

- Question 1: What's your full name? (Short Text, required)
- Question 2: What's your email address? (Email, required)
- Question 3: What's your phone number? (Phone, required)
- Question 4: Which county and state do you live in? (Short Text, required)
- Question 5: Who would be filing? (Single Choice, required). Options: Just me; Me and my spouse
- Question 6: Roughly how much do you owe in total? (Single Choice, required). Options: Under $10,000; $10,000 to $50,000; $50,000 to $100,000; Over $100,000; Not sure
- Question 7: Which kinds of debt do you have? (Multiple Choice, required). Options: Credit cards; Medical bills; Personal loans; Car loan; Mortgage; Student loans; Back taxes; Business debt
- Question 8: Is any of this happening right now? (Multiple Choice, required). Options: Foreclosure on my home; Wages being garnished; Car repossession; A creditor is suing me; Collection calls; None of these
- Question 9: What's your work situation? (Single Choice, required). Options: Employed full time; Employed part time; Self employed; Retired or on disability; Not working
- Question 10: Do you own a home? (Yes / No, required)
- Question 11: Have you filed for bankruptcy before? (Yes / No, required)
- Question 12: Do you already have a lawyer for this? (Yes / No, required)
- Question 13: Anything else we should know? (Long Text, optional)
- Question 14: When is the best time to call you? (Single Choice, required). Options: Morning; Afternoon; Evening

## 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

## 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.