Initial Consultation - Jim Ross Law Group, P.C.

CLIENT INFORMATION

Name

Home Address

City

State

Zip Code

County of Residence

Date of Birth

Social Security

Driver's License

Home Phone

Cell Phone

Email Address

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

City

State

Zip Code

Phone

EMERGENCY CONTACT

Name

Relationship

Home Address

City

State

Zip Code

Phone

Email Address

OPPOSING PARTY INFORMATION

Name

Relationship

Home Address

City

State

Zip Code

Phone

Email Address

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?

INITIAL CONSULTATION INFORMATION SHEET

CLIENT INFORMATION

EMPLOYMENT INFORMATION

EMERGENCY CONTACT

OPPOSING PARTY INFORMATION

HOW DID YOU HEAR ABOUT US?