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Provide Us A Brief Personal Background of the Person Needing Assistance.

Many times we are contacted by someone other than the person in need of help, such as a parent on behalf of a child, or wife on behalf of a husband. Please provide the following information on behalf of person who needs assistance.

The following information is for myself: Yes No

If "no," my relationship to the following person is:

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Why Do You Need Help?

Please provide us with a very brief summary, in 15 words or less, describing in general the subject matter of your request. You can provide more detailed information later, but for now please confine yourself to providing us with a brief overview. Here are some examples of what your summary should say.

Personal Injury Examples:  You were involved in an automobile accident where the other person was at fault.  You were walking through an aisle of the grocery store and slipped and fell on a foreign object.  You were physically assualted by someone without provocation.

Civil Rights Examples:  Your relative was injured killed by police officers without probable cause using excessive or inappropriate force.

Criminal Case Examples:  You were stopped for Driving Under the Influence of alcohol or drugs.  You were arrested for possession of illegal drugs, assault, child molestation, or some other serious crime.

Consumer Fraud Examples: Insurance company discriminates against people with X condition or disability; ABC Company is defrauding consumers who buy its lightbulbs; my contact lens company sells three different lenses which can be worn for different periods at different prices, but they are all the same product.

Small Business Examples: I have a franchise with XYZ Corporation and other franchisees are getting preferential treatment; RST Company took a down payment for a franchise and never returned my money.  You need to form a new business.  You need to evaluate the form of your present business operation.

Please type a very brief summary, in 15 words or less, describing in general the subject matter of your request in the box below.

State the date you were injured or when you first learned that you had been damaged?   (if an injury or civil rights case or damages case)

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How did you find out?

For example: when it happened; my doctor diagnosed my child with X; the bank told me they could not make the loan because my land was poisoned.Please type in the box below how you found out:

Where did it happen?

Please type in the City and State where it happened in the box below:

Who do you suspect or believe caused the harm?  (Injury/Civil Rights/Damages Cases)

Please type in the names of all the wrongdoers involved below:

Please type in the full address of all wrongdoers below:

What damages were suffered?

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Has anyone already filed a suit?

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What else should we know to help you?

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How Can We Help You?

What is your goal? Explain here what you hope to achieve by working with a qualified lawyer on this issue.

When is the best time to reach you by telephone? (Indicate your time zone - e.g. PST, EST, etc.)

If the information you have provided is complete, please press the Send button below to send it to us. If you wish to start over, press the Clear all fields button below and re-enter all information. Your information will be kept confidential.

Please note that we are licensed only in the State of Georgia.  We occasionally accept cases outside of the jurisdiction where we can associate local counsel.  We will attempt to refer you to other counsel in other cases.