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Welcome To LRS
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35
Questions
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1
Attorney Name
Type your name
First Name
Last Name
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2
Firm
Please provide your firms name
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3
Email
Please provide us with your email address
example@example.com
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4
Phone Number
What is the best number to contact you?
Area Code
Phone Number
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5
Client's Name
Enter Client's First and Last Name
First Name
Last Name
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6
Date of Loss
Enter the date the injury occurred
/
Date
Month
Day
Year
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7
Date of Settlement
Enter the date the case was settled
-
Date
Month
Day
Year
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8
Email
Enter client's email address
example@example.com
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9
Phone Number
Enter client's cell phone number
Area Code
Phone Number
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10
Did you obtain medpay?
YES
NO
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11
If you answered yes, please enter the amount obtained
Enter amount of medpay collected
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12
Enter retainer %
Was this obtained pre-lit/Post filing/Post Arbitration
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13
Did you obtain a 3rd party settlement?
YES
NO
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14
If you answered yes, please enter the amount obtained
Enter amount of 3rd party settlement
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15
Enter retainer %
Was this obtained pre-lit/Post filing/Post Arbitration
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16
Did you obtain a 1st party settlement?
YES
NO
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17
If you answered yes, please enter the amount obtained
Enter amount of 1st party settlement
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18
Enter retainer %
Was this obtained pre-lit/Post filing/Post Arbitration
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19
Upload fully executed retainer
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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20
Who is the referring attorney?
Select referring attorney
Bergener Mirejovsky, APC
Law Offices of Eleanor Miller
Law Offices of John Oh
Rafii Nazarian
Dayan Houman
Bergener Mirejovsky, APC
Law Offices of Eleanor Miller
Law Offices of John Oh
Rafii Nazarian
Dayan Houman
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21
Fee Split Agreement
As per 2-200
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22
Upload Addendum
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Max. file size
: 10.6MB
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23
Advanced Case Costs
Enter your costs
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24
Co-Counsel Advanced Case Costs
Please email co-counsel to see if they have any costs
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25
Outstanding Deposition Charges
Deposition & Court Reporter Charges
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26
Wexco International (Expert)
Site Inspection for premises liability matters
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27
Upload itemization of costs
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Max. file size
: 10.6MB
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28
Dont feel like entering the medicals, just upload them! We'll do the work for you.
Drag and drop files here
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Max. file size
: 10.6MB
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29
Add Medicals One By One
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30
Does your client have a child support lien?
YES
NO
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31
Enter child support contact
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32
Enter child support agent phone number
Area Code
Phone Number
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33
Please tell us what the client is expecting to recover
Very important that we keep our promises to the client
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34
Signature
By submitting this form, you understand that LRS is not responsible for bills that are omitted. LRS is not responsible for the payment of any liens on referred matters. LRS will not be responsible or named in legal issues that may arise.
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35
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