PIAA Form - Present Your Case.

Please navigate to the Intake Forms menu above and download the documents pertinent to your case. Carefully review, complete and save the documents. For your convenience, only sections 1 and 2 of the HIPAA form require completion at this time; please initial and sign the form in the designated area at the bottom.

Once completed, you may either return the scanned documents via email or upload them using our PIAA online form. Should you require any clarification or assistance in completing these forms, please do not hesitate to contact me directly.

Legal Category

Designate the type of lawyer you need based on legal issue(s) that best fit your case.

How soon are you looking to hire an attorney?

Kindly Provide a One-Line Summary of Your Case.

State why you need an attorney.

What is the Issue you Want to Resolve?

State the highlights/major facts that support your claim.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

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