Contact information:

Name(s) of lawyer(s):

_________________________

Firm name:

_________________________

Address:

_________________________

City:

_________________________

State/Zip:

_________________________

Telephone(s):

_________________________

Fax(s):

_________________________

Email address(es):

_________________________

Areas of expertise:

State(s) licensed to practice in:

Types of cases handled (check all that apply):

___ Civil cases
___ Class-action lawsuits
___ Criminal cases
___ Disabled adult abuse
___ Disabled adult neglect
___ Elder abuse
___ Elder neglect
___ Estate planning
___ Financial exploitation
___ Fraud
___ Home health services abuse/neglect
___ Living trusts
___ Medical malpractice
___ Mental health care facility abuse/neglect
___ Nursing home abuse/neglect
___ Residential facility for the developmentally disabled, abuse/neglect
___ Residential facility for elders and/or adults with disabilities
___ Undue influence
___ Wills
___ Other:_______________________
___ Other:_______________________

Particular areas of expertise (Up to 200 words):

Fees:

Initial in-person consultation is free
__Yes __No Time limit: ____

Initial phone consultation is free
__Yes __No Time limit: ____

Typical fees or fee arrangements:

Other

Other things potential clients should know about us (Up to 200 words):