Clinic Appointment Request Form

Clinic Appointment Request Form

PLEASE READ: Our November 8th clinic will be taking place in person at Brentwood Arts Exchange ( 3901 Rhode Island Ave, Brentwood, MD 20722). There will be no virtual component to the November clinic. Please fill out the form below to request a clinic time slot. If your requested time is approved, you will receive a confirmation email. Your time slot is not finalized until you receive the approval email.
Request a clinic slot*
Name*

First NameLast Name
Email*
example@example.com
Pronouns
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What county do you live in?*
Cell Phone*
Please enter a valid phone number.
Race*
What type of artist are you?*
What type of legal issue are you having?*
Detailed description of legal issue*
Do you have any files or documents that may need further review by an attorney?*

YesNo
Do you have a digital copy of these files or documents?*

YesNo
Should be Empty: