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Employment Discrimination Intake Form

Please take a moment to fill out this employment discrimination intake form so we can set up a Free Consultation. Once we have a chance to review your submission, we will reach out to set up a time to talk. Your submission will be kept100% confidential.

Type of Discrimination You are Experiencing
Does Your Employer Know About the Mistreatment?
How Did Your Employer Become Aware of the Mistreatment?
After Your Employer Became Aware of the Mistreatment, did it continue?
Do You Have Witnesses?
Do You Have Evidence?

Thanks for submitting! We will review your submissions and be in touch as soon as possible to set up a free consultation.

Please note, by submitting this form, it does not mean that we represent you. The only way we will represent you is after we have fully investigated your claims AND mutually agree to the terms of representation, which must be outlined in a written retainer agreement signed by you and this Firm. Unless and until we agree to represent you and execute a retainer agreement, you are personally responsible for all aspects of your claims, including and and all deadlines that you may have.

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