Authorized Contact~br~Form (Adds to Outlook)

Authorized Contact/Spouse Form

Please use this form to add any authorized contact to our databases. This includes any spouse that may not have been run through Intake when scheduling an EP appointment or any other authorized contact we have received a Communication Authorization for.

Once submitted, this will automatically add them as a contact in Outlook and MyCase. Please see the Intake Supervisor if you have any questions.

First Name *
Last Name *

Address
Address 2
City
State
Postal Code

Phone Type
Number

Matter Name they are affiliated with: *

Notes to be added to Outlook & MyCase *

Your initials *