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Rob Wiley, P.C.


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Civil Rights Intake Questionnaire

If you want the Law Office of Rob Wiley, P.C. to evaluate your employment matter, please fill out this questionnaire.  Unfortunately, we cannot guarantee a response to every questionnaire, nor does completing a questionnaire mean that we will undertake your representation. 

Do not forget to click the "Submit" button when you are done.

    • Please enter your full name:

      First Name
      Last Name
      Middle Initial
      Title
       
    • Please enter your full address:
      Street Address
      Address (cont.)
      City
      State/Province
      Zip/Postal Code
      County
      Country
       
    • Please enter your home, an alternate telephone number and e-mail address:
      Work Phone
      Home Phone
      Cellular Phone
      E-mail

       
    • Please enter your gender:

      Male  Female
       

    • Birth date:

      -- mm/dd/yy
       

    • Driver's License Information
      D.L. #
      State

       

    • Please identify any organization(s) and/or any individual(s) that you believe violated your civil rights:


       

    • Please explain how you believe your civil rights were violated:


       

    • Please explain how you were damaged.  Did you lose wages?  Was your property damages?  Were you mentally or physically hurt?


       

    • Who referred you to our law firm?
      Name
       
    • Please tell us any other information you believe would help us in evaluating your
      claim:

Do not forget to click the "Submit" button when you are done.

 

  
 

Turtle Creek Tower 310
3131 Turtle Creek Boulevard
Dallas, Texas 75219
(214) 528-6500
Fax:  (214) 528-6511

THIS WEBSITE IS AN ADVERTISEMENT.  THE USE OF THIS WEBSITE IS NOT INTENDED TO AND DOES NOT CREATE AN ATTORNEY-CLIENT RELATIONSHIP.  THIS SITE CONTAINS ONLY GENERAL INFORMATION.  EVERY LEGAL SITUATION IS UNIQUE AND REQUIRES SPECIFIC LEGAL ADVICE.  THIS WEBSITE DOES NOT PROVIDE SPECIFIC LEGAL ADVICE.  DO NOT RELY ON ANYTHING CONTAINED IN THE WEBSITE WITHOUT CONSULTING AN ATTORNEY.  THE DALLAS BAR ASSOCIATION MAINTAINS A FREE ATTORNEY REFERRAL LINE AT (214) 220-7444.

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