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Investigation Assessment Form

Client Information

 Name:
 
 Phone:
 
 Cellphone:
 
 Address:
 
 City:
 
 State:
 
 Zip Code:
 
  Email:
 
 Fax:
 
 Proposed Assignment Date:
 
 Best way to communicate:
 
 Give a brief description of the nature of your case:
 
Is Attorney involved:
 
Attorney’s name:
 
 Signature:
 
Date:
 
 

This is not a binding agreement but a request for review of a case. This information is strictly confidential and will properly discarded.