Clinic Appointment Request Form

Clinic Appointment Request Form

⚠️ If you are unresponsive to staff communications before the clinic, MDVLA reserves the right to cancel your clinic appointment. ⚠️ Our November Clinic is currently full. Please monitor your email for waitlist communications.
Request a clinic slot
Name

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What county do you live in?
Birthday

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
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?
Please upload the relevant file. MDVLA will not accept documents exceeding 5 pages in length for review at the Art Law Clinic.

Cancelof
I understand that November's clinic will take place on Zoom with no in-person appointments and certify that I will attend virtually at my confirmed appointment time.
Should be Empty: