Your Name (required)
Your Email (required)
Identify the employer or company with which you have a legal problem:
Approximately how many employees does this company have?:
What was/is your salary with this company?:
Briefly describe your legal problem:
If you were terminated, were you offered any severance?:
If so, how much?:
Have you signed a waiver or release of legal claims?:
All communications between you and Cole|Reichek, PLLC, including this questionnaire, are privileged, which means that they will be kept in the strictest confidence by the firm. Please note, however, that Cole|Reichek, PLLC’s provision and review of legal advice or any agreement to represent you. No attorney-client relationship will be formed unless and until a Legal Services Agreement is executed between you and Cole|Reichek, PLLC. This questionnaire will be destroyed if Cole|Reichek, PLLC does not represent you.
Please check this box to agree to the above terms.