Consult Form | Law Offices of Monty J. Buhrow Portal

Office Consultation Information Sheet

INSTRUCTIONS: Answer all questions truthfully and completely. The information you provide in this questionnaire is confidential and protected by the attorney-client privilege. The information will not be disclosed to anyone outside this office, except in the course of rendering legal services on your behalf or unless otherwise required by law.

Your Contact Information

Name *

First

Middle

Last

Physical Address (No PO Boxes)

Company Name (If Applicable)

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home or Business Address? *

Home
Business

Work Phone

Mobile Phone

Drivers License Number

Your company's EIN or your Social Security Number *

Home Phone

Email *

Date of Birth *

How / where / from whom did you hear about our office? *

Which of the three options are true of your objectives for today's meeting?

Objectives

You came in expecting or intending to hire an attorney today.
You don't know whether you need an attorney and thus are not sure whether you're going to hire an attorney today. You might or might not.
You know you are not going to hire an attorney but need to get some questions answered anyway.

Your Legal Concern

Using the categories shown, identify the general nature of your legal concern. Choose all that apply.

Concern *

You are: *

The party complaining (the plaintiff)
The party being complained about (the defendant)
Both parties are complaining about each other

Using only the space provided, describe the nature of your dispute or your legal need: *

Lawsuit Status

Does your legal concern involve a lawsuit already in progress? *

Yes
No

Have you been served with a lawsuit? *

Yes
No

If served with a lawsuit, have you filed anything with the court yet? *

Yes
No

Name of the opposing counsel/law firm, if known:

Opposing Party Identification

Name

Company Name (If Applicable)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Home or Business Address?

Home
Business

Work Phone

Mobile Phone

Home Phone

Email

Is the opposing party: *

Incorporated
Not incorporated
An individual
Unknown

Disclaimer and Signature

A one-time consultation fee applies to this consultation. The cost of the consultation is payable at the time you submit this form. Although the attorney will review a limited number of documents at no additional cost in the course of the consultation, should it be deemed necessary to conduct an independent review of same, such will be performed at an additional charge, with the cost of such determined on a case-by-case basis.

You acknowledge and agree that this appointment is a consultation only and does not mean LAW OFFICES OF MONTY J. BUHROW, PLLC is therefore representing you in your above-stated legal concern. The firm will only represent you after you sign a legal services retainer agreement and pay any applicable retainer. If a retainer agreement is not signed at the end of the consultation, neither the attorney nor the firm are representing you in the matter and hence there will be no obligation on their part to take any action regarding the legal concern(s) addressed during the consultation.

The undersigned represents that the information supplied above is true and correct. By checking the box below and typing out your full legal name, the undersigned agrees that he/she has not hired LAW OFFICES OF MONTY J. BUHROW, PLLC nor does it represent him/her merely by reason of this consultation.

I agree with the above statement? *

Yes
No

Signature *

Clear Signature

AFTER CONSULTATION: LIMITED RELEASE FOR INTERNET / SOCIAL MEDIA

Many clients search the internet for legal advice and/or for the best attorney to work with on their legal situation. No surprise then, this firm works hard to maintain a vibrant internet existence, hoping to locate clients searching for our services. Part of that vibrant internet existence is to continuously provide new and meaningful content on our website and on various outside social media sites. That’s where you come in.

It won’t surprise you that other people are afflicted with legal concerns comparable to yours. We like to think those people might benefit from the insights we provide and if appropriate by working with us. And for that reason, and only if you consent, we would like to be able to discuss the legal themes presented in your case on our website and/or on our social media outlets. In making this request, it is paramount that you hear from the very outset that none of your confidential information will be discussed at any time. We would merely discuss the generalized legal themes presented through your case. But again, no names, no addresses, and no other material sufficiently specific to identify you would ever be disclosed through those internet-based discussions.

We will only have that online discussion with your specific consent and with such consent given AFTER you’ve completed the consultation itself. If you would – after the consultation is complete – please indicate whether you consent to such by checking the box next to the applicable line below. Thank you for your consideration.

Social Media Consent *

YES, I authorize mjbLAW to discuss the generalized legal issues presented in my case on social media, PROVIDED HOWEVER that mjbLAW will not disclose any facts specific to my situation and PROVIDED FURTHER that this consent in no wise waives, reduces or abrogates the attorney-client privilege.
NO, I do not authorize mjbLAW to discuss anything on social media related to my case, even if such is generalized in nature.

Signature *

Clear Signature

Consult Payment

Billing Name *

First

Last

Billing Email *

Receipt will be sent to this email address upon completion of payment.

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Type consult payment amount: *

Payment Information *

Card Number

Expiration

/

Security Code

Portal for the Law Offices of Monty J. Buhrow, PLLC

Office Consultation Information Sheet

Your Contact Information

Physical Address (No PO Boxes)

Which of the three options are true of your objectives for today's meeting?

Your Legal Concern

Lawsuit Status

Opposing Party Identification

Disclaimer and Signature

AFTER CONSULTATION: LIMITED RELEASE FOR INTERNET / SOCIAL MEDIA

Consult Payment