Thank you so much for contacting Liberty Loyal Law (Liberty Loyal LLC)! Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.

DO NOT INCLUDE ANY DETAILED INFORMATION ABOUT YOUR POTENTIAL CASE on this form or until our staff has been able to properly perform checks for legal or ethical conflicts. This is to prevent conflicts as well as to better maintain attorney privileges.

Privacy Policy

Our Firm maintains HIPPA-compliant security practices. We strongly believe in and fight for full Attorney-Client Privilege and your right to privacy wherever possible.

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. Any data submitted via the forms provided is encrypted and secured using industry-standard 256-bit SSL encryption.

Your Social Security Number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

Social Security Numbers are most often used to positively identify parties and conduct records searches. Most courts and Agencies require Social Security Numbers of all parties in a case. Some other examples of how this information may be used include:

initial service
in court orders
in required reports or other documents filed with the State or Federal Government

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!

Contact information: Your Information

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

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Phone numbers

Phone number

Type

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Contact information: Emergancy Contact or Next of Kin

Prefix

First name *

Middle name

Last name *

Date of birth

Emails

Address *

Type

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Today's Date

Please provide a subject for your consultation. (examples: considering a divorce; interested in starting a business; VA appeals; need a will)

Contact information: Your Information

Gender

Marital Status

Military or Veteran Status

Please include your branch[es] of service, time frames, and rank.

Social Security Number (please note, we are compeltly HIPPA compliant)

Driver's License Number

Please list any other names you have ever been known by, including maiden names.

Contact information: Emergancy Contact or Next of Kin

Are you currently employed?

Preferred Contact Method

How were you referred to our law firm?

If our law firm ends up representing you in this matter, will you be the person who pays the legal fees?

Are we now, or have we ever represented you or someone close to you.

If you are contemplating filing a law suit, please list the party or parties you think should be named.

Are you requesting an In-Person Consult? Please note, we have more availability for virtual and phone consultations through the link on our website.

Please acknowledge that you have read and hereby accept the above privacy policy regarding use of my personal information by typing your full legal name below

THANK YOU