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Goolsby Attorney At Law
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Richard Hays Goolsby Jr.
(706) 726-6798
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Georgia Criminal Defense Attorney

Please Fill Out This Form to the Best of Your Ability. Filling out this form does not create an Attorney-Client Relationship between you and I. However, all information submitted will be kept confidential.


Your Full Name:
Your Home Phone Number:
Your Cell Phone Number:
Other Phone Number:
Your Mailing Address:
Kind of Criminal Matter:
When Were You Arrested:
State You Were Charged In:
County You Were Charged In:
Your Date of Birth:
Other Important Information:
Questions You Have:

Filling out this form does not create an Attorney-Client Relationship between you and I. However, all information submitted will be kept confidential.


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