CONFLICTS SCREENING INTAKE FORM

The purpose of this intake form is to gather basic information from you for performance of the Firm’s conflicts of interest screening.

If the initial screening reveals no conflicts of interest, you may be asked to provide us more detailed information later.

Please do not send highly confidential information, as there are risks associated with the use of such technology.

(There are risks of interception of electronic communications to which a third party may gain access, such as malicious hackers and potential mis-sendings, and other inadvertent or intentional disclosures. By using this contact form, you accept these risks)

Contacting us in any manner does not constitute the creation of an attorney / client relationship.

Conflicts Check

First Name

Middle Name

Last Name

Maiden Name (if applicable)

Any Aliases Used

Phone

Street Address

City

Region/State/Province

Postal / Zip code

Briefly Decribe the Natue of Your Legal Issue

Name(s) of Persons or Business you have legal dispute with

Thanks for submitting!

PLEASE READ CAREFULLY

NOTICE: This Firm does not yet represent you with regard to the matters set forth by you in this information sheet unless and until both you and the Attorney execute a written Attorney/Client Fee Agreement.

If your legal problem(s) involve a potential lawsuit, it is important that you realize a lawsuit must be filed within a certain period of time called a Statute of Limitations. Therefore, if this Firm notifies you that we will not represent you following our conflicts check, the Firm strongly urges you to immediately consult with another attorney to protect your rights. In the event the Firm or Attorney decides not to represent you, this should not be taken as an expression regarding the merits of your case.

By submitting this form, you acknowledge that you have read this Notice and does not mean you have hired the Attorney.

Thompson Legal Assistance, LLC

Law Firm
Registered in Iowa

DEVELOPING INNOVATING SOLUTIONS

Conflicts Check