New Client Intake Form

Request a 1-Hour Phone Consult

*The fee for a 1-hour consultation is $350. The consultation fee is due at least 24 hours before the time of the scheduled appointment. For criminal defense cases, there is no consultation fee.
Your Full Name *

First Name M.I. Last Name Suffix
Case Type

Traffic Criminal Defense Employment
Email
example@example.com
Phone Number

Area Code Phone Number
Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Preferred method of contact

E-MAIL PHONE CALL TEXT
Date of Birth

Month Day Year
Date
Occupation
Employer
Have you filed with EEOC or DDOL?

Yes (if checked, please provide the status in the below description box) No
Please tell us a bit about what you would like to discuss during your consult. *
Include dates of employment and EEOC/DDOL status (if applicable).
AVAILABILITY FOR A PHONE CONSULT *
Please provide at least one date/time of availability between M-F and we will get back to you to schedule.
How did you hear about us?
Attach documents (optional)

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Request a 1-Hour Phone Consult