Contact Us        
While we would be pleased to speak with you about potential representation or mediation services, do not send us e-mail containing information about your case other than the data requested on the inquiry form below unless we specifically ask for such information. If you are interested in arranging for us to represent you or to provide mediation services, we ask that you telephone our office at (304) 367-9482 during regular business hours or complete the potential client contact form provided below. We cannot consider potentially representing you or providing mediation services and do not want details of your matter until we have evaluated whether a conflict of interest may exist that would make representation or mediation in that matter inappropriate.
If you are interested in scheduling an initial consultation or retaining our mediation services please telephone our office or complete this form. Only potential clients should complete this form; do not submit this form on someone else’s behalf.

( * indicates required entries )
I am interested in scheduling (check one): *
    free initial consultation (For the purpose of the attorney learning more about my
            situation and to see if the attorney might represent me in my case. I understand that
            this does not include any legal advice.)
    paid consultation (For the purpose of finding out about my rights generally. I
            understand that this does include limited legal advice but is not designed to prepare
            me to represent myself in a case and that the attorney will not be helping me or
            instructing me how to complete pro se forms.)
    mediation session (I understand that you would not be representing either party
            and will not be giving legal advice.)
Your First Name: *
Your Last Name: *
Other/Previous Last Names: *
    (Please type "none" if you have not been
    known by any other last names. For women,
    please make sure to list your maiden name
    and any former married names.)
City Where You Reside: *
State Where You Reside: *
    (use 2 character state code abreviation)
Email Address: *
Is this your email address?: *    yes    no
If no, whose email address is it?
    (provide full name)
I authorize the Law Offices of Marci R.
Carroll to contact me at the above email
address for the limited purpose of scheduling
an initial consultation or mediation.  *		        (please check)
Opposing Party's First Name: *
Opposing Party's Last Name: *
Opposing Party's Other or Previous
   Last Names: *
    (Please type "none" if they have not been
    known by any other last names. For women,
    please make sure to list thier maiden name
    and any former married names.)
Have any papers been filed with the
   court?:		    yes    no    don't know
If yes, did you file the papers?:    yes    no
If no, what date did you receive the
   papers?		   mm    dd    yyyy
Are there any court hearings scheduled?:    yes    no    don't know
Date of hearing:   mm    dd    yyyy
Time of hearing:   hh    mm  a.m.  p.m.
County of hearing:
How did you hear about our office? *
Area(s) of Law Involved in My Case: (check all that apply)*
       Divorce
       Paternity
       Child Support (establishment or modification)
       Child Custody/Visitation/Parenting Plan (establishment or modification)
       Domestic Violence
       Adoption
       Modification of Existing Order
       Appeal
       Contempt/Enforcement of Existing Order
       Grandparent Visitation
       Relocation of a Parent (where minor children are involved)
       Alimony/Spousal Support (establishment or modification)
       Child Support Arrearage
       Miscellaneous Post-Divorce Issues
       Other
I am generally available for an appointment on the following
  days: (check all that apply)
                 Monday   Thursday
                 Tuesday   Friday
                 Wednesday
The earliest time I am generally available
  for an appointment is: (select one) 
I generally need an appointment to be
  completed by: (select one) 
Please be advised that our office will complete a preliminary conflict of interest check and will contact you via email, usually within 24 hours, with a proposed appointment date and time.
         
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Law Offices of Marci R. Carroll • Suite 500 • WesBanco Building • 301 Adams Street • Fairmont, WV 26554-3168
Phone: (304) 367-9482 • Fax: (304) 367-9633
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