Potential Legal Representation

Questionnaire

A representative from Brown, Goldstein & Levy will contact you to discuss this information. Note: Although the information you provide to us on this form is confidential, completion and/or submission of this form to us does not create an attorney-client relationship between Brown, Goldstein & Levy (the “Firm”) and you. No attorney-client relationship shall exist until you and the Firm make a mutual decision to work together and make a written agreement stating the specific terms of that attorney-client relationship. While this questionnaire does not create an attorney-client relationship, your information will be confidential and privileged. We will not disclose your information and you may not be compelled to disclose your communications with us to anyone. If you have time deadlines (or statutes of limitations) that are quickly approaching, we cannot guarantee that we will respond in time for us to assist you in filing a lawsuit or administrative agency complaint. You should take immediate action to avoid missing any such deadlines.

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