MBLA Attorney Referral Program: Client Survey

The MBLA Referral Program aims to connect MBLA member attorneys with clients in need of legal services. Completing this form does not create an attorney-client relationship between you and the MBLA, nor does it guarantee that you will be paired with an attorney who will ultimately take your case.

Date*
Date Format: MM slash DD slash YYYY
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Legal Issue:*
Please select the option that best describes the type of case you have.
- Probate and Family Law
- Employment and Labor Law
- Bankruptcy Law
- Trusts and Estates
- Elder Law
- Immigration Law
- Civil Rights Law
- Criminal Law
- Juvenile Law
- Property Law
- Corporate Law
- Intellectual Property/Patent Law
- Health Law
- Personal Injury Law
- Tax
- Commercial Litigation
Please provide a brief description of your case:*
Note that any information submitted via this form is not subject to attorney-client privilege.
Acknowledgment*
- By submitting this form to the MBLA, I affirm that the above information is true and accurate to the best of my knowledge and that I do not have an attorney-client relationship with the MBLA. I also agree that I will not hold the MBLA liable for any issues that arise as a result of choosing to work with one of the referred attorneys.

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