Professional Licensing & IDFPR Case EvaluationNameEmail AddressPhonePreferred Contact Method: Phone or Email?Phone CallEmailProfession or License TypePhysicianNurse/APRNDentistPharmacistChiropractorPsychologist/Mental Health ProfessionalPhysical/Occupational TherapistReal Estate ProfessionalAccountant/CPAArchitect/EngineerOther Licensed ProfessionalWhat Type of Licensing Matter Are You Facing?License Application or Renewal IssueIDFPR Complaint or InvestigationInformal ConferenceDisciplinary Proceeding or HearingProbation or Compliance MatterSuspension or RevocationAdministrative Review or AppealOther Professional Licensing MatterNot SureHave You Received a Written Notice, Complaint, or Other Communication from IDFPR or Another Agency?Do You Have an Upcoming Response, Conference Hearing, or Other Deadline?Deadline Date, If KnownBriefly Describe Your SituationPlease provide a brief overview of your situation. Do not include Social Security numbers, financial account information, medical records, or other highly sensitive information.Best Time to Contact YouAcknowledgement and CosntentPlease provide a brief overview only. Do not submit Social Security numbers, medical records, financial account information, or other highly sensitive or confidential information through this form. I understand that submitting this form does not create an attorney-client relationship and that Michael V. Favia & Associates has not agreed to represent me unless and until the firm expressly agrees to do so.I Acknowledge and Consent to the SameBefore You Click SubmitImportant: Submission of this form does not create an attorney-client relationship. Michael V. Favia & Associates must review and accept a matter before an attorney-client relationship is established. If your matter involves an imminent deadline, please call the firm directly. Confidentiality Notice: Please do not submit confidential documents or highly sensitive personal information through this form. If your matter involves an imminent deadline, contact the firm directly by telephone.I Read and AgreeI am Not a VendorThis form is not for vendor or sales use, this form is solely for prospective clients in search of legal assistance.AgreeSubmit Form to Request a ConsultationShare on FacebookTweetFollow usSave
