Vermont Legal Resources

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Practice Area*
Applicant's Age (must be between 18 and 65)*
When did your condition first begin to affect you?*
Has your condition caused you to stop working or substantially reduce your work hours?*
Have you applied for social security disability?*
Are you currently being treated by a doctor?*
What is your total debt?*
What is your total monthly income?*
Do You Own Real Estate?*
What is the estimated value of your assets?*
What is your role in this matter (do not complete form if you are a victim)*
When was the alleged crime committed?*
How will you pay legal fees if you hire a lawyer*
Total employees that work for the business*
The Employer is a*
Of What Country Are You a Citizen?*
How will you pay legal fees if you hire a lawyer*
Immigration Issue*
The person with the immigration matter is*
Status of the Claim*
When Did the Incident Occur?*
Primary Injury*
Prior Alcohol Related Offenses*
Type of Alcohol Test Performed*
Blood Alcohol Content Measured By Test*
Status of the Claim*
When Did the Incident Occur?*
Primary Injury*
Cause of Injury*
Do You Have Children*
Marital Status*
How will you pay legal fees if you hire a lawyer*
Was a Police Report Filed?*
When Did the Incident Occur?*
Primary Injury*
How will you pay legal fees if you hire a lawyer*
When did the charge occur?*
What type of charge?*
Case Description*

VERMONT LEGAL RESOURCES