Attorney Referral Form

We are very grateful that many of our clients are sent to us by other lawyers. In fact, in our opinion there is no greater honor than to receive a peer referral or enter a co-counsel arrangement with our fellow lawyers. We are pleased to pay co-counsel fees in accordance with 4-1.5 of the Florida Rules of Professional conduct.

If you would like to refer a client to our law firm and have us evaluate the case to determine whether we can help, please complete the following form. A representative of The Umansky Law Firm will contact you to discuss the case in detail and make arrangements concerning the referral and/or co-counseling the case. Of course, we will not contact the client until we have spoken with you.

Bold labels and indicate required information.

Client Information

Name Please provide client name.

Street Address Please provide client street address.

City Please provide client city.

State Please the state client lives in. Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Please enter client zip code.

Phone Number Please enter client phone number.

Alternative Number

E-mail Address Please enter client's valid e-mail address.

Best Time to Contact

Type of Claim Please enter client's type of claim.

Brief Description of the Incident

Referring Attorney Information

Name Please enter your name.

Primary Practice Area Please enter your Primary Practice Area.

Street Address Please enter your Street Address.

City Please enter your City.

State Choose a state from this list. Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Please enter your zip code.

Phone Number Please enter your phone number.

E-mail Address Please enter a valid e-mail address.

Best Time to Contact

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

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