326 Monroe Street, P.O. Box 119 Jefferson City, MO 65102 Phone: 573-635-4128 Fax: 573-635-2811
To schedule appointments for referred clients in a timely manner.
To “abide by the rules of the service and in no event hold, or claim to hold, the association or any of its officers, members or employees liable in connection with the operation of, or use of the information contained in the application in connection with the activities of the service.”
Law School Graduated From & Date
Year admitted to practice in Missouri
Other States or jurisdiction where you are admitted to practice None
Other Professional Degrees & Licenses
Yes No Installment payments possible after initial consultation
Yes No Home visits possible
Yes No Evening Appointments
Yes No Office Handicapped Accessible
Foreign Languages in which I am reasonably fluent
Please list the counties for which you are willing to receive referrals.
Policy Agreement
I represent that I am licensed to practice in Missouri, that I am covered by a Professional Liability Insurance policy with limits of not less than $100,000/$300,000 and that I will maintain this policy throughout the period of my participation in the service. (see Rule IV.D.(3).)
I further state and agree that the staff person who receives a request for referral which I ultimately accept is acting as my employee and/or agent and shall be bound by the attorney-client privileged communication rule regarding any information which is communicated to such person during the process of referral.
I will abide by all the rules and regulations of the Missouri Bar Lawyer Referral Services.
Liability Insurance Carrier
Policy No.
Checking this box indicates you agree to the above policy.
Check the areas in which you will accept referrals.
ADA Issues Adoption Adoption - International Agricultural Alternative Dispute Resolution Animal Law Appeals Arbitration Asbestos Auto Accidents Auto Law Banking Bankruptcy - Business Bankruptcy - Personal Business Law Business Organization Issues Car/Truck Title Problems Child Abuse Child Custody Child Support Child Visitation Children's Rights Civil Rights Class Action Cases Collections Computer Technology Conservatorship Consumer Advocacy Issues Consumer Law Contract Law Copyrights Corporate Law Creditor Problems Criminal Debt Restructuring Discrimination Divorce Driver's License - Hardship Driver's License - Revoked Driver's License - Suspension DUI/DWI Cases Education Law EEOC Issues Elder Law Eminent Domain Issues Employment Law Employment Benefits Employment Discrimination Entertainment Environmental Issues ERISA Estate Planning Expungements of Criminal Records Family Law Farm Law Father's Rights Federal Federal Employment Federal Workers' Compensation Foreclosures Franchise Law Grandparent's Rights Guardian Ad Litem Issues Guardianship Harassment HIPAA HUD Cases Identity Fraud Immigration Insurance - Auto Insurance - Defense Insurance - Health Insurance - Life Insurance - Plaintiff Intellectual Property Internet Issues IRS Problems Juvenile Labor Law Land Use Landlord Rights Legal Separation Lemon Law Livestock Living Trusts Local Government Law Malpractice - Dental Malpractice - Legal Malpractice - Medical Mediation Medicaid Medicare Mental Health Issues Military Mobile Home Problems Mold Litigation Name Change Nursing Home Problems Occupational Diseases Orders of Protection Patents Paternity Pensions Personal Injury - Slip & Fall Personal Injury - Vehicle Power of Attorney Pre-nuptial Agreements Probate Probation Violation Product Liability Professional Licensure Property Damage Real Estate - Commercial Real Estate - Residential Re-instatement of Driver's License Retirement Issues Security Clearance Issues Sex Crimes Small Claims Social Security Social Security - Disability - SSI Social Security Appeals Special Education Problems Speeding Tickets Stocks/Bonds/Securities Sunshine Law Matters Taxation Temporary Restraining Orders Tenant's Rights Trademark Traffic Violations Trucking Industry Issues Trusts Underground Storage Tank Problems Unemployment Utilities Veterans' Affairs Veterans' Rights Wage Disputes Warranties 65" />Warranties - Autos Warranties - Other Products Wills Workers' Compensation Workers' Compensation Appeals Wrongful Death Please specify any additional areas or explain any "restrictions" or any other information that would be helpful in referring clients to you. How would you prefer to receive future communications from the Missouri Bar Lawyer Referral Service? E-mail Address Fax Number Regular Mail When form is completed, click "Submit Form" to e-mail to the Missouri Bar Lawyer Referral Service.
Please specify any additional areas or explain any "restrictions" or any other information that would be helpful in referring clients to you.
E-mail Address Fax Number Regular Mail
When form is completed, click "Submit Form" to e-mail to the Missouri Bar Lawyer Referral Service.
