Intake Form
Please take a few minutes to complete this form, so the attorney can review your case.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
How did you hear about us?
*
Please Select
Advertisement
ARAG
Google Search
LegalShield Referral
Referral from Client
State Bar of Texas
Texas Legal
LegalEASE
Other
Referral:
*
Do you have legal insurance?
*
Yes
No
Please select your provider.
*
Please Select
ARAG
Texas Legal
LegalShield
LegalEASE
ARAG Case Information
*
Member ID
Case Assist
LegalEASE Case Number
*
Are your attorney benefits paid in full?
Yes
No
I'm Not Sure
Texas Legal Information
*
Subscriber ID
LegalShield Case Number
*
Subscriber ID
Please select your preferred attorney
Please Select
Michael Dooley
Tim Bernadt
Unsure
Does your legal matter involve a dispute of any kind with another party?
*
Yes
No
Provide a brief description of your matter.
*
Does your matter involve any Court dates or Deadlines?
Yes
No
Court date or Deadline.
-
Month
-
Day
Year
Date
Please provide a desired outcome.
*
Please upload any documentation to support your claims.
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Please provide contact information of the opposing party.
*
Additional Information
Submit
Should be Empty: