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Potential Client Questionnaire
   
Potential Client Name:
Your Name If Different:
E-Mail Address:
Phone:
Address:
Fax:
Referred By (If Applicable)
Nature of Complaint
(e.g., legal malpractice,
medical malpractice, etc.)
Name the Person(s) or Business
Against Which You Think
You Have A Claim
Explain Why You
Think You Have a Claim
How Much Damage Did
You Suffer as a Result?		 $250,000 $500,000 $1,000,000 $5,000,000
When, Specifically, Did
These Events Happen?
In What State Did
These Events Happen?
If Your Potential Claim is
Against Your Former Lawyer,
When Did That Lawyer Most
Recently Perform Legal
Services for You?
 

                  

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