At The Coles Firm, we understand you may have a dispute with a current or former employee or employer. We also know you may wish to seek advice and consultation regarding these disputes. To that end, we have provided the following questionnaire for your convenience. Please complete all the information below and someone from our office will contact you shortly.

CONFIDENTIAL INTAKE QUESTIONNAIRE





An email address is required.Please enter a valid email address.









Please detail any benefits you received from the employer at issue, including but not limited to health, vision, dental, 401K, and/or dependant coverage.






  

 



 
  






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The use of the Internet or this form for communication with The Coles Firm P.C. or any individual member of The Coles Firm P.C. does not establish an attorney-client relationship. If you have an emergency situation or anything of a time-sensitive nature, please contact us by telephone at (214) 443-7862.