File-It-Your Self Registration Form

File-It-Your Self Registration Form
Select a Pricing Plan
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Type*
Phone Number*
E-mail*
example@example.com
Service Details:
Have you previously applied for North Carolina Legal Aid?*
Type of Legal Service Required*
Preferred Method of Contact*
Brief Description of the Legal Issue:*
Relevant Dates (e.g., marriage date for divorce, filing date for bankruptcy):*
Desired Outcome:*
Court/Jurisdiction (if known):*
Additional Comments or Requests:
How did you hear about us?*
If other please specify*
If other please specify*
Legal Advice Disclaimer:
I acknowledge and understand that the services provided are for assistance with self-filing paperwork and do not constitute legal advice. The provider of this service is not an attorney and cannot offer legal advice or representation. This service is limited to professional assistance with the preparation of documents and does not include any legal consultation or advice. It is my responsibility to review, verify, and file the documents with the appropriate court or agency. I understand that if I have any legal questions or require legal advice, I should consult with a licensed attorney
I acknowledge and agree to the above disclaimer and understand that this service is not a substitute for legal advice. I accept full responsibility for reviewing and filing my documents.
Waiver of Liability
Task Force Legal Solutions does not provide legal advice, representation, or advocacy as an independent paralegal service. We assist attorneys, organizations, and individuals with administrative, procedural, and research-related concerns. Attorney-client relationships cannot be formed by Task Force Legal Solutions because we do not practice law.

By checking the box below, you acknowledge and agree that:
- The client acknowledges and agrees that our services are limited to paralegal assistance and do not constitute legal advice.
- Task Force Legal Solutions is not liable for any decisions or outcomes resulting from your reliance on information provided during our work.
I acknowledge and agree to the Waiver of Liability.
Consent to Review Medical Records
Medical records or related documents may be reviewed to provide comprehensive support tailored to your needs. We require your written authorization to access, review, and analyze such information.

Checking the box below indicates your consent to Task Force Legal Solutions:
- Medical records will be accessed, reviewed, and securely stored according to written authorization.
- Information will be used only in accordance with our service agreement.
I consent to the review of my medical records.
Authorization to Access HIPAA-Protected Information
Health Insurance Portability and Accountability Act (HIPAA) requires us to obtain your permission before handling any protected health information (PHI). Task Force Legal Solutions upholds strict confidentiality standards and implements safeguards to protect your sensitive data.

Checking the box below authorizes Task Force Legal Solutions to:
- Receive and access your HIPAA-protected information as needed to perform our contracted services.
- Share relevant information with authorized parties only to the extent necessary to fulfill the agreed-upon tasks.
- Maintain your privacy and confidentiality in accordance with applicable laws and professional standards.
I authorize access to my HIPAA-protected information.
Acknowledgment and Authorization
By submitting this form, I, {fullName3}, confirm that I have read and understood the terms of this waiver of liability, consent to review medical records, and authorization for access to HIPAA-protected information. I voluntarily agree to these terms.
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I consent to the review of my medical records.
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File-It-Your Self Registration Form

Service Details:

Legal Advice Disclaimer:

Waiver of Liability

Consent to Review Medical Records

Authorization to Access HIPAA-Protected Information

Acknowledgment and Authorization