Appointment Scheduling

Please use the following form to schedule an appointment with this office.

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First Name
Last Name
City
Address Street 1
Address Street 2
Zip Code
Daytime Phone
Evening Phone
Language
Date of Appointment
date_range
Time Of Appointment (hh/mm)
I would like make an appointment with your office on the time and date indicated above.  I agree to pay $100 consultation fee for the appointment and I will be billed $100 attorney's fee if I fail to show up without canceling the appointment 12 hours ahead of time.
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