Consultation Form

We review intake forms at least once a week, after which you will be contacted to let you know if we can set up a consultation or if we need to refer you to a different firm/lawyer.

At our firm, every potential case or attorney-client relationship starts with a consultation. This initial consultation usually takes about an hour and can be done over the phone or by video. We do charge a fee for this consultation.

The form below will assist us with getting this process started. The information you submit is confidential, meaning we will not disclose it to anyone outside of the firm. Please fill it out as completely as you can (first and last names where you can), as we use it to review for any conflicts of interest.

If you need help filling out the form, please call our office.

Your first and last name *

Preferred Pronouns *

Your email address *

Phone Number *

Street Address *

City *

State *

Zip *

How did you hear about us? *

EMPLOYER INFORMATION

Who do you work for? *

Private Employer

Government Agency or department

What is the name of your employer? *

Are you part of a Union? If so, which one?

What department do you work in?

What is/was your position and briefly, what are/were your job duties?

What is/was your last rate of pay?

Approximately how many employees work for your employer?

What office or location do you work from or are you assigned to?

How long have you worked/did you work for your employer?

Did you supervise any employees?

Yes

No

How many?

Who was/is your supervisor?

Are there other supervisors or employees who have been involved in your situation at work? If so, what are their names?

Do you know of any deadlines that are coming up, or meetings or hearings that have been scheduled? If so, what dates/deadlines?

SPECIFIC INFORMATION ABOUT YOUR SITUATION

Why do you need to see a lawyer? *

Terminated

Resigned

Resigned under threat of termination

Demoted/disciplined

Still employed

Other

Date of Separation (if applicable)

Has your employer taken negative actions against you like discipline, suspension, demotion? Please explain what and when.

Do you need advice about ongoing problems at work?

Yes

No

Do you need us to review any documents or agreements (such as severance agreements, non-compete agreements, or employment agreements)?

Yes

No

Do you need to be represented because of an upcoming hearing or meeting?

Yes

No

Other issue(s)

Do you feel you have been discriminated or harassed because of:

Your race or color:

Your national origin

Your religion

Your age

Other Reason

Do you believe your employer has retaliated against you because you did one or more of the following?

Reported discrimination/harassment

Reported fraud

Reported corruption

Reported illegal activity

Reported waste

Spoke out on an important matter

Participated in an investigation

Other

Other Reason

Do you believe you have been wrongly terminated? If so, why?

Are there other issues or concerns that you have about any of the following? (Check all those that apply.)

Not being paid overtime or proper wages

Contract issues (such as non-compete agreements, severance agreements, or employment contracts)

Union activities

Unemployment compensation

Disability insurance

Retirement

Severance

None of these

Provide a brief explanation of why you marked the boxes above and/or a description of your issues:

Provide critical documents (doc, docx, pdf)

Drag and drop files here or Browse

DAMAGES

Have you lost any wages as a result of the actions taken against you? If so, how much?

What other damages or injuries have you suffered?

Have you had to seek medical help (including going to see a counselor) as a result of the actions taken against you? Explain briefly.

We charge $300 for our initial hour consultation. Are you willing and able to pay? *

Yes

No

Would you like us to email you a referral list?

Yes

No

Do you have a preference of which attorney you consult with?

Yes

No

If so, which attorney?

We review intake forms at least once a week and after we do so you will be contacted to let you know if we can set up a consultation or if we need to refer you to a different firm/lawyer.

Completing this form does not form an attorney-client relationship.