Civil Litigation Questionnaire Disclaimer: Completing this form does not create any attorney-client relationship. Thus, no information provided by you shall be considered confidential or protected by an attorney-client confidentiality until our office is officially and adequately retained as your attorney and allowed a full opportunity to review for any conflict of interest. Your First Name: * Your Last Name:* Company: Name of Opposing Parties, Please list: Name of Co-Defendants, Please list: Have you been sued?: Yes No If so, when were you served?: What is the case number?: Where is the place of dispute?City: State: Court Location, if any: Estimated amount in dispute or amount claimed:$ Are you currently represented by an attorney? Yes No Do you have a former attorney? Yes No If you had a former attorney, what was your former attorney's name? Please list the names of any former attorneys you have discussed this matter with: Are you a plaintiff or a defendant? Plaintiff Defendant If you are a plaintiff, what are your claims? If you are a Defendant, what are the claims that you/your company were sued for? (Please check all that apply): Breach of Contract Business and Partnership Dispute Breach of Fiduciary Duty Collections Construction Defect Contractor Licenses Consumer Violation Copyright & Patent Defamation and Libel Dog Bite Employment Declaratory Relief Disabilities (ADA - Unruh) Discrimination Employment (Wage & Hour) Employment (Overtime) Employment (Sexual Harassment) Employment (Wrongful Termination) Employment (Discrimination) Fraud Medical Malpractice Malpractice (Legal) Personal Injury (Auto Accident) Product Defect Real Estate Related Slip & Fall Wrongful Death Other Please describe claims or causes of action not listed above: Brief Comment on Case: (Disclose only non-confidential matters): Do you have a copy of your Complaint? Yes No Please provide a copy of your complaint (Only accepts .jpg, .jpeg, .png, .bmp): Acceptable file types : jpeg,jpg,png,bmp As discussed in your consultation agreement, Attorneys will not review documents in a consultation as that will require significant time and research. However, Attorneys may briefly review the complaint or pleadings in order to obtain a background to facilitate a meaningful evaluation and consultation. I acknowledge that the foregoing information I am providing is solely for the purpose of having my case reviewed. I understand that the submission of this information does not form an attorney-client relationship. I certify that the information I have provided in this questionnaire is true to the best of my knowledge and belief.