Client Assistance

The form below is for members to be able to connect clients to the our list of attorneys interested in taking on cases. If there is interest in a case, the names and contact info for the attorney will be sent to the client or referring party.

We cannot guarantee that one of our member attorneys will be able to represent this client, but we will do our best to connect them.

Information for Person Filling Out Form

Name

First Name

Last Name

Referring Organization

For example, "Legal Aid Society", "Bronx Defenders", or N/A if none.

Phone

(###)

###

####

Information for Client

Name

First Name

Last Name

Pronouns / Honorifics

What pronouns and honorifics are appropriate to address the client?

Phone

(###)

###

####

Date of Incident or Estimated Date

Please use this format: Month/Date/Year. If you don't know, please write "Unsure".

Describe Case and Injuries

Does the client currently have an open criminal case as a result of this incident?

Yes

Unsure

Is there documentation of the incident and/or injuries?

This could include video, photographs, or documentation from a hospital.

Yes

Unsure

Emergency Contact or Family Contact

Is the client currently incarcerated?

Yes