request a consultation

Request a Consultation

Thank you for taking the time to fill out our consultation request form.  Kohn, Kohn & Colapinto, LLP has a national practice focusing on assisting individuals who witness or want to report fraud, misconduct or abuse, or who have experienced discrimination, or suffered retaliation due to "whistleblowing."

This consultation request form will assist us in evaluating your case and figuring out if KKC is a good fit for the representation you may need.

It is KKC's strict policy that the consultation form you submit shall remain confidential. Regardless of whether we agree to represent you, we consider the submission and content of this form to fall within the confines of the attorney-client and work-product privileges and will treat the information we receive accordingly.

Please understand that, although your communication with us may be privileged, we are not your attorneys at this time.  Should we mutually agree to enter a representation arrangement, we will enter into a formal written agreement with you setting forth the scope and terms of our legal representation.

Again, thank you for contacting us.

KKC can now accept credit card payment for your convenience.

Consultation Request Form

 

 

Name
Address
City
State
Zip Code
Home Telephone Number:
Work Telephone Number:
What is your preferred method of contact?
Phone: Fax: Email:
Which telephone number would you prefer that we call?
Home: Work:
E-mail
May we contact you by e-mail?
Yes: No:
Profession/Job title:
Employer:
That company's location (city, state):
City:
State:
Have you witnessed fraud , misconduct or abuse?
Yes: No:
If yes, please describe including pertinent dates.
Does the potential case involve tax fraud, fraud against the government, or contract fraud?
Yes: No:
If yes, please describe including pertinent dates.
If fraud has been committed at the expense of a governmental entity please provide the name of the agency or governmental entity that has been defrauded.
Has there been a public disclosure of your case or the fraud in any media?
Yes: No:
Have you suffered from discrimination or retaliation?
Yes: No:
If yes, please describe including pertinent dates.
If you lost your job, have you filed or are you considering filing a wrongful termination lawsuit? Please describe any action you have taken in this regard.
Do you have a case pending before a court or an administrative agency? Please list:
If yes, please tell us the name of your case the current status:
Do you currently have an attorney, or were you represented by an attorney in this matter or a related matter?
Yes: No:
If yes, please provide us with contact information for the attorney:
Are you a member of a union?
Yes: No:
Are you covered by a Collective Bargaining Agreement?
Yes: No:
Are you covered or have you signed an agreement requiring you to submit claims to binding arbitration or to keep information confidential?
Yes: No:
Please provide the date on which the most recent wrongful event occurred:
Were you referred by anyone to our office?
How did you hear about or find Kohn, Kohn & Colapinto, LLP?