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Intake Form to Request Legal Assistance

Please note that we may not respond immediately but we will respond asap.

Dear Potential Client: Please complete the form in its entirety to the best of your availability and provide any supporting documentation. All information will be used in assessing your case.

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Your contact details

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Your story

Step 3/3

Supporting Information

Click Yes if you agree.

This intake form does not give legal advice, and you should not rely on it as legal advice. You should not rely on the information you got from this site and should speak with a lawyer to get advice on your specific situation. We also cannot promise that the information on this site is complete, accurate and/or up-to-date.

This form is not a solicitation or an offer by JULIAN and its affiliates to represent you. We cannot promise you that the information you provide will likely lead to any specific action on the part of JULIAN or its affiliates. Once you complete the form, JULIAN may not do anything-including contact you-about your situation.

If you fill out this form, you agree that JULIAN or one of its coalition partners may use the information you give us, as long as we don't include your name, address, email or phone number, for one or more of the following purposes: (1) legislative testimony, (2) litigation, (3) contacting a city, state or federal agency, (4) telling your story to the public, including the media. If JULIAN or one of its coalition partner want to identify you, we will contact you prior to doing so.

We will keep your name, address, telephone number and email address confidential unless you give us permission to use or or unless we are ordered to turn it over by a court (Although we will attempt to prevent any disclosure).

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