HARVEY-JACOB LAW INTAKE FORM

Thank you for your interest in working with us. Please fill out the information below. Please be aware that filling out the form does not create an Attorney-Client relationship. However, the information you provide will be kept confidential.

After review, we will contact you regarding an Initial Consultation to discuss your matter further. If we choose not to invite you or are unable to assist we will contact you to let you know.

By filling and submitting this form you acknowledge that you accept our Terms of Service and Privacy Policy.

You can review them by clicking on the following links:

Contact and Personal Information:

Contact information

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

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Phone numbers

Phone number

Type

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Legal Issue(s)

Our Rates and Fees

Please note, our legal services are offered on a flat rate basis. This means no hourly rates! Before working with us, or signing an engagement agreement, you will be given the cost upfront, so there will be no surprises.

Initial 10-Minute Chat

You may book a 10 minute chat at no cost to ask questions and so we can determine if and how we can help you.

Initial Consultation

Our initial consultation, if required, is payable in advance (unless waived), and is non-refundable.

Service Rates

Should you choose to retain us for an additional service within two weeks of the Initial Consultation, up to 50% of your initial consultation fee will be credited to the legal service. Our services across all areas are payable in advance.

If you have a legal insurance provider, your fee payment will be arranged according to your coverage. We will be able to provide you with the rate of service after your initial consultation, as we’ll know more about your issue and will have evaluated the work, time, and resources required.

Unless otherwise determined, a non-refundable retainer may be required to secure our availability.

Your Inquiry

Thank You & Next Steps

Thank you so much for completing this preliminary intake questionnaire. Your information will be extremely helpful in evaluating your application.

We will contact you as soon as possible with any updates.

Please click the SUBMIT button below when you have finished answering all questions.

Contact and Personal Information:

Contact information

Legal Issue(s)

Nature of issue(s):

Please describe the legal issue you need help with:

If your issue involves an opposing party or parties, please provide the name(s). Type "N/A" if not applicable.

What outcome would you like to have?

Our Rates and Fees

Please state whether you understand the above note and that you have made the necessary financial assessment in seeking legal assistance with Harvey-Jacob Law.

Your Inquiry

How did you hear of Harvey-Jacob Law?

If you received a referral, please let us know who referred you.

If you are requesting assistance under insurance coverage, please share your policy number and the name of your insurance provider.

Please Upload a Copy of 1 Valid Photo ID Document ~ (required)

Please check the box below if you agree to the Privacy Policy (per above instructions).

Please check the box below if you agree to the Terms of Service (per above instructions).

Please check the box below to acknowledge you understand that the firm does not accept attachments via email. If supporting documentation is required, it will be requested for you to upload securely.

Thank You & Next Steps