Potential Client Intake Form

So that we may understand your needs, please complete and submit the following short intake form. It should take no more than a few minutes to complete. A representative from Keil & Siegel LLP will respond to your inquiry promptly. There is no cost or obligation associated with submitting this form.

Please be advised that while we will treat your information with utmost of care, the submission of this information does not create an attorney-client relationship between you and our firm. Do not submit information that is confidential.

Please call us at  (516) 767-2383 with any questions or concerns. If you have a general question, please complete the form on our contact page.

Once the form is submitted successfully, you will receive a message at the bottom of the page indicating success. Please call if you have any concerns whether your message arrived. Thank you.

    Your Name (required)

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    What service do you have interest in? (required)
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    Please let us know how we may potentially help you.

    I understand that the use of this form for communication with Keil & Siegel LLP does not create an attorney-client relationship. (required)

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