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Attorney–Client Privilege Questionnaire

In order for us to know if we can be of help to you, we ask that you fill out the confidential, attorney-client privileged questionnaire below. In almost all circumstances, we will get back to you within 48 hours of receipt of this form.

For emergency situations, please contact our office manager, Kelly Amador, at 856.914.9200.

In the event that an initial consultation is scheduled, the fee for that consultation is $375 per hour, payable at the time of the consultation.

In asking you to fill out this questionnaire, Schall & Barasch LLC is not agreeing to take legal action on your behalf or to represent you in any way. Any agreement by this law firm to take any legal action for you must be agreed to in writing and signed by an attorney of this firm. This document is not such an agreement.

1. Last Name, First Name

2. Date (MM/DD/YY)

3. Street Address

City:    State:   Zip Code:

4. Home Telephone:

5. Work Telephone:
(Only if we can call you there)

6. Cell Phone:

7. Home E-mail Address:

8. Best Time to Call:

9. Name of Company/Organization for Which You Worked, or Still Work.

10. Street Address of Company:

Company City:    State:   Zip Code:

11. Date of hire at this company? (MM/DD/YYYY)

12. Your Age, and Date of Birth: (MM/DD/YY)
Age:   D.O.B.

13. Job Title/Description

14. Your salary or hourly rate of pay

15. Briefly describe how you feel your employment rights were violated or explain the issue about which you are concerned.

16. When (on what date) did these events occur?

17. Do you think you were discriminated against because of your age, sex, sexual orientation, disability or history of disability, race, national origin, taking a family and/or medical leave, whistleblowing, or any other factor? If yes, please explain.

18. Is there any other information that may help us understand why you feel your rights were violated by your employer?

19. How have you been damaged, or will be damaged, by your employer's actions?

 20: How did you hear of Schall & Barasch? Please be specific:

 

     

Schall & Barasch LLC
Attorneys At Law

Moorestown Office Center
110 Marter Ave., Suite 302
Moorestown, NJ 08057

Tel. 856.914.9200
Fax 856.914.9420

Attorney-Client Privilege Questionnaire - Schall & Barasch

This website is designed to provide general information only. It does not provide, nor is it intended to provide, legal advice of any kind. Instead, if you are in need of legal advice, you should consult with an attorney of your choosing who can review with you your individual situation.