Initial Consultation

Attorney/Client Privileged

The information provided on this form is confidential and protected by Attorney-Client Privilege. The information will not be disclosed to anyone outside of Jim Ross Law Group, P.C., except in the course of rendering legal services on your behalf or otherwise required by law.

CLIENT INFORMATION

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

County of Residence

Date of Birth

Social Security

Driver's License

Home Phone

Cellphone

Authorization

I authorize emails concerning my case
I authorize emails of general interest from Jim Ross Law Group, P.C.

EMPLOYMENT INFORMATION

Employer

Job Title

Work Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

EMERGENCY CONTACT

Name

First

Last

Relationship

of Birth Home

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

OPPOSING PARTY INFORMATION

Name

First

Last

Relationship

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

NATURE OF CASE: Reason for seeking consultation with our office:

If Personal Injury:

Date of Accident

City of Accident

DESIRED OUTCOME: What would you like to see accomplished at the completion of your case?

HELPING INJUREd
in DFW

HELPING INJUREd
in DFW

HELPING INJURED
in DFW

Our team has successfully secured tens of millions of dollars in verdicts and settlements for our clients.

Initial Consultation

CLIENT INFORMATION

EMPLOYMENT INFORMATION

EMERGENCY CONTACT

OPPOSING PARTY INFORMATION

If Personal Injury:

20 Years

Experience In Personal Injury Law

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817-275-4100

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