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Request/Schedule Appointment

This request form requires users to give us their name and email address, demographic information such as valid mailing address (with zip code) and other important contact information. As we value your privacy, and the confidential nature of your request, the information provided will be kept with the highest degree of confidentiality between you and the Firm.

The Firm will try to reach you the soonest possible time. You will be informed of our consultation fees and we will arrange for your appointment upon your confirmation.

You may complete and submit this form online, but please note that any information submitted over the internet may not be 100% secure while in transit. If this is a concern, you may print our Client Questionnaire Form (pdf) and submit it to us by mail or by fax. Our mailing address, phone and fax numbers are indicated at the bottom of this page.

If you are in the United States, please provide your 10 digit phone number. International visitors are requested to provide E-mail address for prompt response.

Name (Last, Middle, First):

Title:

Company:

Address:

E-mail:

Phone:

Please note and agree to the following before sending your request.

This is to confirm that I have not yet decided to retain the legal services of Marsha Edelman P.C. has the said Firm decided to accept my case. Marsha Edelman P.C. is under no obligation to represent any of the parties mentioned in this form.

Yes, I Agree


 

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