Contact Us

Reeves Law Firm, P.A.
P.O. Box 580570
Kissimmee, Florida 34758
Toll-Free (Phone/Fax): (888) 962-0007

contact@reevesfirm.com

Office Hours:
Kissimmee: Monday – Friday: 9:00am – 5:00pm

Lakeland: By Appointment Only

Do You Have A Case?

(Download the pdf document you need pertaining to your case or fill out the online form below)

Criminal Case Intake Sheet

Family Case Intake Sheet

Labor & Employment Case Intake Sheet

Social Security Case Intake Sheet

Workers Compensation Case Intake Sheet

Online Form
Name*
FirstLast
Address*
Street AddressCityStateZip Code
Email*
Phone*
Type of Case*
Type of Labor & Employment Case*
Were you terminated? *
- Yes
- No
If yes, when?*
Did you quit?*
- Yes
- No
If yes, when?*
Have you filed a charge with the EEOC / FCHR?*
- Yes
- No
If yes, when?*
Have you received a verbal reprimand?*
- Yes
- No
Have you received a written reprimand?*
- Yes
- No
What are the reasons you believe was the cause for your termination / quitting?*
- Race
- Age
- Sex
- Disability
- Retaliation
- Whistleblower
- Workers Compensation
How many employees does your employer have?*
What was your salary?*
What was your job title?*
How long did you work for the employer?*
Type of Family Case*
Divorce
How long have you been married? (years and months)*
Do you own a home with your spouse?*
- Yes
- No
Do you own any other property with your spouse? *
- Yes
- No
Do you have any debt with your spouse?*
- Yes
- No
Are you working? *
- Yes
- No
What is your monthly wages?*
Is your spouse working? *
- Yes
- No
What is your spouse’s monthly wages?*
Are there minor children involved?*
- Yes
- No
How many children?*
What are the ages of your children?*
Custody
Do you have custody of the minor child? *
- Yes
- No
Do you have a court ordered parenting plan? *
- Yes
- No
Are you seeking primary custody (majority time sharing)?*
- Yes
- No
Why are you seeking primary custody?*
Social Security
Is this your case?*
- Yes
- No
Who is this case for?*
Have you applied for Social Security?*
- Yes
- No
Have you been denied Social Security?*
- Yes
- No
Did you appeal the denial?*
- Yes
- No
Are you currently getting treatment from a doctor?*
- Yes
- No
When was the last time you received treatment?*
What medications are you taking?*
Are you still working?*
- Yes
- No
What is your job title?*
How often do you work?*
- Full Time
- Part Time
How many hours a week do you work?*
Do you smoke?*
- Yes
- No
Do you drink?*
- Yes
- No
Have you ever used illegal drugs? *
- Yes
- No
When was the last time you worked full time? *
What job did you do for the longest period of time?*
How long (yrs/months/days)? *
Have you ever been represented by an attorney before?*
- Yes
- No
Is your medical condition (impairments)?*
Please list your conditions that keep you from working?*
What type of physical providers are you seeing? *
- General
- Chiropractor
- Specialist
- Family
- None
What type of mental providers are you seeing? *
- Psychiatrist
- Psychologist
- Therapist
- Family
- None
Date of Birth*
Do you owe child support in any jurisdiction? *
- Yes
- No
Education (Select the highest grade completed)*
Did you graduate?*
- Yes
- No
College (Select the highest level completed)*
Did you graduate?*
- Yes
- No
Degree received*
Employer / Carrier Information
Employer Name*
Mailing Address*
Street AddressCityStateZip Code
Supervisor*
Phone*
Your job title*
Length of time with company*
Workers Compensation Carrier*
Mailing Address*
Street AddressCityStateZip Code
Adjuster / Claims Representative*
Phone*
Your wages at the time of your injury*
Are you still employed by the company?*
- Yes
- No
Explain?*
Accident Information
Place of accident (include city and county) *
Date of accident*
Brief description of accident*
Body parts (injured)*
Medical providers in order of treatment:*
Date employer was notified of accident?*
How was employer notified?*
Third party involved? *
- Yes
- No
Explain third party involvement?*
Any prior WC accidents or other accidents?*
- Yes
- No
Explain prior accidents?*
Was a written or recorded statement taken by anyone? If so, by who and when?*
Work Status
Did your doctor release you back to work?*
- Yes
- No
Date returned to work?*
Returned to work for:*
- Previous Employer
- New Employer
Employer's Name*
Mailing Address*
Street AddressCityStateZip Code
Phone*
Salary at new job?*
Next Court Date*
Prior Criminal History (if any)
1. Charge
When
Sentence?
2. Charge
When
Sentence?
3. Charge
When
Sentence?
Current Charges
1. Charge
2. Charge
3. Charge
Employment
Employer
Occupation
Paternity
Have you taken a DNA test? *
- Yes
- No
Are you paying child support?*
- Yes
- No
Are you trying to establish paternity? *
- Yes
- No
Are you trying to determine your child support obligation? *
- Yes
- No
Visitation
Do you have custody of the minor child? *
- Yes
- No
Do you have a court ordered parenting plan?*
- Yes
- No
Where is the minor child residing?*
Do you wish to change the visitation schedule?*
- Yes
- No
Why do you wish to change the visitation schedule?*
Alimony
Are you court ordered to pay alimony? *
- Yes
- No
Do you want to reduce your alimony payments? *
- Yes
- No
Why do you want to reduce your alimony payments? *
How did you find out about this firm?
Briefly describe the facts of your case?*

Pay Your Legal Fee Now

Reeves Law Firm, P.A.

Contact Us

Do You Have A Case?

Online Form

Divorce

Custody

Social Security

Employer / Carrier Information

Accident Information

Work Status

Prior Criminal History (if any)

Current Charges

Employment

Paternity

Visitation

Alimony

Pay Your Legal Fee Now