Mold Case Attorney Intake Form: Meeting with an Attorney

Personal Information

Last Name: _______________ First Name: _______________
Maiden Name: _______________
Other names used___________________________________

Contact Information
Email address_______________
Home phone number _______________
Work phone number _______________
Home address:

Please answer the following to the best of your ability:

I suspect a mold problem at:
____My place of business
____My home

If the suspected mold problem is at your home, when was the home built?______________
If you did not build your home, when did you purchase it?_______________

Please place an “X” next to any of the following warning signs if you have noticed them at your home or place of business:
____Visible mold growth
____Discoloration or water stains on internally facing walls or ceilings
____Discoloration or water stains on externally facing walls
____Areas of standing water or condensation on floors, walls, or window sills
____Musty odor

Please place an “X” next to any of the following health effects if you have experienced them:
____Worsening of allergies
____Respiratory problems
____Nasal and sinus congestion
____Burning / watering eyes
____Worsening of asthma
____Sore throat
____Flu-like symptoms
____Skin irritation

Please list the name of the General Contractor who built your home (if applicable):

Any other information or concerns?

Would you like to discuss your legal matter?


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Jack Morgan CALL US! 866-205-4971

We will assist in scheduling new and existing clients for all offices. For initial consultations we will ask you a few questions and then find the best time for you to talk to one of the lawyers that best fits your legal matter.

Call us or use the email form and we will follow up with you right away.


The Law Offices of Hogan Injury will provide you with personalized attention and guidance. Protecting your rights is our main objective. We have been representing clients for the past 30 years and our experienced team of attorneys will advise you of the legal consequences of every decision you take.