First Name *

Last Name

Street Address

City

State/Province

ZIP / Postal Code

Email Address *

Phone Number *

Preferred Contact Method *PhoneEmailMail

2. MetLife Legal Plan Details

MetLife Eligibility # *

Employer Name *

Case Number (If assigned)

3. Legal Issue Information

Type of Legal Issues

Other

Brief Description of the Legal Matter

Urgency/Time-Sensitivity

Any Previous Legal Actions Taken

If Legal Action has taken place please provide

Case number

Which County was the Action Filed In?

Status

4. Appointment Scheduling Preferences

Preferred Time for Initial Consultation

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Preferred Date for Initial Consultation

Preferred Mode of Consultation *In-PersonPhoneVirtual (Zoom, Teams, etc.)

5. Files you would like to share with Fistel Law Group

Additional Documentation *YesNo

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Additional Note