Have you ever received a speeding ticket?

• [ ] Yes
• [ ] No

Have you been involved in any legal disputes that required going to court?

• [ ] Yes
• [ ] No

Have you ever been wrongfully charged with a crime?

• [ ] Yes
• [ ] No

Do you believe you have been treated unfairly by someone (e.g., employer, neighbor, business)?

• [ ] Yes
• [ ] No

Have you experienced any discrimination or harassment?

• [ ] Yes
• [ ] No

Have you ever faced challenges with insurance claims or benefits?

• [ ] Yes
• [ ] No

Do you need assistance with conflict resolution?

• [ ] Yes
• [ ] No

Have you encountered legal issues related to contracts or agreements?

• [ ] Yes
• [ ] No

Are you seeking legal engagement coaching or personalized advice?

• [ ] Yes
• [ ] No

Is there anything else you’d like to share or ask? [Open text field for additional comments]