Case Review Request

What is the Case Review Form?

The Case Review Form is a form that you fill out to provide details about your case. We have designed the Form to provide the most important details we believe are necessary for an evaluation of your case. The more information you provide, the easier it is for us to fairly evaluate your case. We will gladly review the form for free and let you know if we think that we can handle your case. If we can, we will contact you promptly to set up a further discussion. If we cannot, we try our best to provide some referral for your matter.

First Name

Last Name

Address

City    State

Zip Code

Telephone

Email Address


Please provide the name of your current or former employer, your position, and a general description of your employer’s business and what you do in your position:

Please provide a brief description of your employment problem, question, or issue and the date on which it arose: