Consultation Intake Form -- Free Review to See if We Can Help You

HARRIS LAW OFFICE
REQUEST FOR CONSULTATION

First Name *
Last Name *
Address *

City *
County
State *
Zip Code *
Home Phone
Work Phone
Cell Phone
Email
Optional information which may assist us in the response
Age
Sex	Male Female
Marital Status	Single Married Other
Job Description
Date of Incident
Web Site

Please contact me by:

Question Topic:

If you would like us to review the possibility of a claim, please provide the facts and circumstances surrounding your case; Please state the extent of your injuries, if any. The more information that we have from the onset, the better our understanding of the case and, therefore, the more in-depth our evaluation of the case and its merits can be.

Please use this area to summarize the important facts of your case. Include dates, names, nature of dispute/injuries.

I understand and affirm by checking the following box that neither the submission of a question to Harris Law Office nor the rendering of a response from Harris Law Office creates an attorney-client relationship. This questionnaire is intended for information purposes only. An attorney-client relationship does not begin until a valid Attorney Retainer Agreement is signed by all parties. Accepted

Thank you for completing this form. We make every effort to respond to inquiries within 24 to 48 hours. At times, however, we have commitments in other matters which may preclude us from responding within this time frame. In those instances, we will endeavor to response as soon as possible.