Delegal Law Offices

Professional Licensing Questionnaire


Have you been given notice that any agency is planning to review your certification status or take action against your certification?

What license or certification do you hold for which you have received notice of pending action?

If you hold any other licenses or certification for which you have not received notice of pending action, please list here.

What notice have you received?

On what date did you receive notice?

What allegations have been made against you?

If any previous adverse action has been taken against your certification or license, please describe.

If any disciplinary action has been taken against you by any employer related to the present allegations, please describe.

How did you learn of our firm?


Additional Information

Please provide any additional information about yourself or the case which would help the attorneys understand you potential case or explain your answers to the above questions.


Scheduling

We will contact you by phone or email unless you request some alternate means of communication.

PLEASE READ THE FOLLOWING STATEMENTS AND INDICATE YOUR ACCEPTANCE OF THESE TERMS PRIOR TO SUBMITTING THIS FORM

I have prepared the answers to these questions to the best of my ability.

I understand that the submission of this form does not create any obligation for me or for any attorney at Delegal Law Offices.

I further understand that submission of this form does not create an attorney-client relationship and that the lawyer is not obligated to schedule a meeting with me.

I understand and agree that Delegal Law Offices, P.A., will have no duty to keep confidential the information that I am transmitting to the law firm through this questionnaire.

YOU MUST AGREE OR YOU CANNOT SUBMIT THIS FORM!

I agree with the terms of this form

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Recent Awards: Tad Delegal Presented the 2017 Non-Compete Seminar portion of the Florida Bar's Certification Review Course

2016 Florida Trend Legal Elite
2015 904 Magazine’s Legal Elite
2015 U.S. News & World Report Law Firm of the Year