Contact Fiedler Law Firm

Johnston, Iowa

8831 Windsor Parkway
Johnston, IA 50131
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P515.254.1999
F515.254.9923

Omaha, Nebraska

17330 Wright Street, Suite 102
Omaha, NE 68130
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P402.316.3060
F402.513.6501

Case Review Form

Wondering if we can help? Using the form below, please give us some of the basic information about your situation. We will then contact you by phone to discuss confidentially. For all inquiries that are not employment related, please contact a member of our staff by email or at either phone number listed above.

YOUR INFORMATION
Name*
Pronouns
Address*
Street Address* City* State*
Email*
Phone*
WHEN IS THE BEST TIME FOR US TO CALL YOU?
HOW DID YOU HEAR ABOUT OUR FIRM?
WERE YOU REFERRED TO A SPECIFIC ATTORNEY? IF SO, WHO?*
EMPLOYMENT INFORMATION
This information helps determine what laws may apply.
NAME OF EMPLOYER*
LOCATION (CITY)
YOUR POSITION/TITLE
DATE EMPLOYMENT STARTED
MM slash DD slash YYYY
DATE EMPLOYMENT ENDED (IF APPLICABLE)
MM slash DD slash YYYY
APPROXIMATE NUMBER OF EMPLOYEES AT YOUR LOCATION
APPROXIMATE NUMBER OF EMPLOYEES COMPANY-WIDE
CASE INFORMATION
This information helps us determine what type of case this may be.
HOW DO YOU BELIEVE YOU WERE DISCRIMINATED AGAINST OR HARASSED?*
Example: Sexual harassment because of constant unwanted advances; Racial discrimination from being passed up for promotions
PLEASE PROVIDE A BRIEF DESCRIPTION OF THE ISSUE(S)
Please be detailed: include specific incidents, dates, people involved, actions you have already taken, etc.
IS THERE ANY OTHER INFORMATION WE NEED TO KNOW BEFORE WE CONTACT YOU?*
Information not covered above that you think we need to know
Submitting this form does not create or constitute an attorney-client relationship with Fiedler Law Firm, P.L.C. Although we don’t have the power to guarantee that information submitted over the internet is confidential, we promise to keep your information strictly to ourselves.

Contact Fiedler Law Firm

Case Review Form

YOUR INFORMATION

EMPLOYMENT INFORMATION

CASE INFORMATION