Inquiry Form for Agencies and Lawyers

This form is to be used by agencies, lawyers and legal clinics that have a client that they wish to refer to us and would like more information about whether or not a particular referral is appropriate.

We only provide services to older adults over 55 who would not otherwise be able to access legal services due to low income or other barriers.

We will respond to your inquiry by email within 48 hours.

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Choose the option that best describes you:
What legal services has the client already had in regard to this or a related problem? (Please limit your response to approx. 100 words)
Will this client be able to speak with us by phone or in person without assistance?
If no, describe the assistance that will be needed. (Please limit your response to approx. 100 words)
Is there any other information you would like us to know? (Please limit your response to approx. 100 words)
Please provide your email address (required).
Please provide your name (required).
Please provide your telephone number (required).

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