The Gary Law Firm


Case Evaluation Form

Please complete and submit the form below.
Your case will be evaluated and we will respond to you shortly.

NOTE: An asterisk (*) indicates REQUIRED information. The use of the Internet or this form for communication with our firm or any individual member of our firm does not establish an attorney-client relationship.

First Name:*
Last Name:*
Address:*
Address:
City:*
State:*
Zip Code:*
Home Phone:*
Work Phone:
Cell Phone:
E-Mail Address:*
Who is the case against?*
Have you discussed this matter with any other attorney?*
 Yes
No
Do you already have an attorney?*
 Yes
No
If yes, why are you looking for another attorney?
Have you filed the matter with any government agency?*
 Yes
No
If yes, which one?
Have you received a right to sue letter from the EEOC or a deter?*
 Yes
No
If so, what is the date on the letter?
Date of incident:*
Has a lawsuit been filed in Court?*
 Yes
No
If yes, where and when was it filed?
Any outstanding court dates?*
 Yes
No
If yes, please explain.
Matter Type, please check one:*
 Wrongful Death
Personal Injury
Medical Malpractice
Commercial Civil
Employment
Other
Please, briefly describe the matter you would like us to review:
Verification No.:*
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The Gary Law Group