QUESTIONNAIRE

We would appreciate it if you would take a few moments by responding to the following questions. This will help us determine an appropriate course of action to take on your case. You do not need to answer these questions, and if you prefer, you may simply contact us at this point by calling (404) 373-1800. Please use our Toll Free number, 1-(866) 373-1800 if you are calling from outside of Georgia or the Metro Atlanta area. We look forward to hearing from you.

Please note that the information you provide will be kept confidential. We will not share your information with any other party without your permission.

General Information

Full Name:

Home Address:

Home Phone:

Work Phone:

e-mail address:

If you are contacting us on behalf of someone else, please provide that person’s name:

Please share the details of your case:

Have you consulted with another attorney:

Yes   No

By submitting this request for information, I agree that I have not entered into an attorney-client relationship and I am at this point only requesting information. I understand that I may only retain an attorney by entering into a fee agreement that will take place if and when it is determined that I have a lawsuit. Moreover, I understand that I will not be charged for a response to my questions set forth above.