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PO Box 605
Clifton Forge, VA 24422

540-660-3370

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INTAKE FORM

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Is the law office permitted to leave a voice message?
Is the law office permitted to send you confidential communications via email?
What is your employment status?
Are you homeless?
How did you hear about K. McConnell Legal, PLLC?
Were you medically separated/retired?
Are you a combat veteran?
Have you served overseas?
Do you currently have a disabiity rating with the Department of Veterans Affairs (VA)?

For the cliams with which you would like legal assistance, please provide the following information.

Claim No. 1

Have you received treatment for this disability?
Have you ever filed a claim for this disability with the VA?
If you have filed a claim with the VA, what was the outcome?

Claim No. 2

Have you received treatment for this disability?
Have you ever filed a claim for this disability with the VA?
If you have filed a claim with the VA, what was the outcome?

Claim No. 3

Have you received treatment for this disability?
Have you ever filed a claim for this disability with the VA?
If you have filed a claim with the VA, what was the outcome?

Additional Information:

If you have access to your most recent VA rating decision documents, please feel free to upload digital copies.

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Terms and Conditions

Please read the following terms and conditions carefully and acknowledge your understanding. In seeking assistance from K. McConnell Legal, PLLC, I understand that:

1. If my case is accepted, I will be represented by a licensed attorney.

2. K. McConnell Legal, PLLC, does not represent every kind of case or every applicant. Submitting this intake form does not guarantee that my case will be represented.

3. K. McConnell Legal, PLLLC, is independent of the Department of Defense (DoD) and the Department of Veterans Affairs (VA) and will be representing my interests, not those of the DoD, VA, or the United States government.

4. Prior to undertaking representation, K. McConnell Legal, PLLC will prepare an engagement letter, detailing the agreement with me, explaining each party's responsibility.

5. I am not represented by K. McConnell Legal, PLLC until I actually meet with the legal office and sign an engagement letter indicating that representation has begun.

Check the box below to acknowledge that you understand and accept the above terms and conditions.

Have you ever received assistance with your claim?

Are you currently receiving help from any of the sources above?

Click "Submit" below to send your intake form to K. McConnell Legal, PLLC.

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