326 Monroe Street, P.O. Box 119 Jefferson City, MO 65102 Phone: 573-635-4128 Fax: 573-635-2811
Website Address Bar Number
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 Administrative Law Adoption Agricultural Animal Law Appeals Arbitration Auto Accidents Auto Law Banking Bankruptcy - Business Bankruptcy - Personal Business Law Business Start-Up Car/Truck Title Problems Child Abuse Child Custody Child Support Child Visitation Children's Rights Civil Rights Collections Computer Technology Conservatorship Construction Consumer Advocacy Issues Consumer Law Contract Law Copyrights Corporate Law Creditor Problems Criminal Criminal - Federal Debt Restructuring DISASTER RELIEF Discrimination Divorce Driver's License - Reinstate 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 Environmental Issues ERISA Estate Planning Expungements Family Law Farm Law Father's Rights Federal Federal Employment Federal Workers' Compensation Foreclosures Franchise Law Gender Law Grandparent's Rights Guardianship Harassment HIPAA HUD Cases Identity Fraud Immigration Insurance - Auto Insurance - Defense Insurance - Disability Short/Long Insurance - Health Insurance - Homeowner's Insurance - Life Insurance - Plaintiff Intellectual Property Internet Issues IRS Problems Juvenile Labor Law Landlord Rights Land Use Legal Separation Lemon Law Livestock Living Trusts Local Government Law Malpractice - Dental Malpractice - Legal Malpractice - Medical Mediation Medicaid Medicare Military Mobile Home Problems Mold Litigation Mortgage Problems Municipal Court Matters Name Change Non-Profit Organization Matters Nursing Home Problems Orders of Protection Patents Paternity Pensions Personal Injury Personal Injury - Slips & Falls Personal Injury - Vehicle Police/Sheriff Matters Post-Conviction Matters Power of Attorney Pre-Nuptial Probate Probation Violation Product Liability Professional Licensure Property Damage Real Estate - Commercial Real Estate - Residential Sex Crimes Small Claims Social Security Social Security Appeals Social Security - Disability - SSI Social Security - Overpayments Special Education Problems Speeding Tickets Stocks/Bonds/Securities Sunshine Law Matters Taxation Temporary Restraining Orders Tenant's Rights Time Share - Vacation Club Trademark Traffic Violations Trucking Industry Issues Trusts Unemployment Unemployment - Appeals Veterans' Affairs Veterans' Rights Wage Disputes Warranties Wills Workers' Compensation Workers' Compensation Appeals Wrongful Death Wrongful Termination Please specify any additional areas or explain any "restrictions" or any other information that would be helpful in referring clients to you. 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.
When form is completed, click "Submit Form" to e-mail to the Missouri Bar Lawyer Referral Service.
