Benezra & Culver, P.C.>Set an Initial Appointment for Non-Employment Civil Rights Case

Set an Initial Appointment for Non-Employment Civil Rights Case

Use the form below to set up an initial appointment for a non-employment Civil Rights case.

PLEASE NOTE: Your responses are protected by attorney/client privilege and will be held in strict confidence.

    Section 1: Contact Information

    First Name (required)

    Last Name (required)

    Address (required)

    Address 2

    City (required)

    State (required)

    Zip/Postal Code (required)

    Contact Phone (Cell or Home) (required)

    Your Email (required)

    Section 2: Potential Defendants

    Name of all potential defendants and their job title (if applicable):*

    Section 3: Adverse Action

    Briefly describe the actions taken against you that you believe may give rise to legal claims against the potential defendants:*

    Section 4: Possible Causes of Action

    Please check the box or boxes for each type of legal claim you believe you may have against potential defendants:

    Police abuse of power, including excessive force or illegal search and seizureDeprivation of Freedom of SpeechImproper deprivation of propertyImproper Invasion of privacyOpen Records violationDefamation, Slander or LibelDiscriminatory government action based on Gender, Race, National Origin, Disability, Age, Sexual Orientation, or any other potentially protected classificationInfringement of right to voteOther

    Section 5: Upcoming Deadlines

    If you are aware of any upcoming deadlines regarding possible claims, please identify those deadlines:

    Section 6: Documents:

    Please bring all relevant documents to your consultation. Err on the side of bringing too many documents as failure to bring all relevant documents will impede and delay our ability to provide you with an opinion regarding your potential claims.