{"id":1978,"date":"2024-07-19T11:47:38","date_gmt":"2024-07-19T16:47:38","guid":{"rendered":"https:\/\/cyclistlaw.com\/?page_id=1978"},"modified":"2025-09-28T23:06:44","modified_gmt":"2025-09-29T04:06:44","slug":"%d9%86%d9%85%d9%88%d8%b0%d8%ac-%d8%b7%d9%84%d8%a8-%d8%aa%d9%88%d9%83%d9%8a%d9%84","status":"publish","type":"page","link":"https:\/\/cyclistlaw.com\/ar\/attorney-request-form\/","title":{"rendered":"\u0646\u0645\u0648\u0630\u062c \u0637\u0644\u0628 \u0645\u062d\u0627\u0645\u064a"},"content":{"rendered":"<h1>\n\t\t\tAttorney Co-Counsel &#038; Referral Request Form\t<\/h1>\n<h2>\n\t\t\t\u0637\u0644\u0628 \u062e\u062f\u0645\u0627\u062a \u0645\u0633\u062a\u0634\u0627\u0631 \u0642\u0627\u0646\u0648\u0646\u064a \u062a\u062c\u0631\u064a\u0628\u064a\t<\/h2>\n\t<p><strong>\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u0627\u062a\u0635\u0627\u0644<\/strong>:<\/p>\n<p><a href=\"mailto:lenore@cyclistlaw.com\">lenore@cyclistlaw.com<\/a><\/p>\n<p><a href=\"tel:+15123868117\">512-386-8117<\/a> (\u0627\u062a\u0635\u0644 \u0623\u0648 \u0631\u0627\u0633\u0644)<\/p>\n<p>\u0628\u0645\u0648\u062c\u0628 \u0645\u0648\u0639\u062f \u0645\u0633\u0628\u0642 \u0641\u0642\u0637.<\/p>\n<h3>\n\t\t\t\u0637\u0644\u0628 \u0645\u062d\u0627\u0645\u064a \u0645\u0631\u0627\u0641\u0642 \t<\/h3>\n\t<p>\u0644\u0644\u0645\u062d\u0627\u0645\u064a\u0646 \u0627\u0644\u0631\u0627\u063a\u0628\u064a\u0646 \u0641\u064a \u0627\u0633\u062a\u0634\u0627\u0631\u0629 \u0642\u0636\u0627\u0626\u064a\u0629\u060c \u064a\u0631\u062c\u0649 \u0645\u0644\u0621 \u0647\u0630\u0627 \u0627\u0644\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0633\u0631\u064a:<\/p>\n                <form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_2' id='gform_2'  action='https:\/\/cyclistlaw.com\/ar\/%d9%86%d9%85%d9%88%d8%b0%d8%ac-%d8%b7%d9%84%d8%a8-%d8%aa%d9%88%d9%83%d9%8a%d9%84\/?fl_builder&#038;fl_builder_ui_iframe#gf_2' data-formid='2' novalidate data-trp-original-action=\"https:\/\/cyclistlaw.com\/attorney-request-form\/?fl_builder&#038;fl_builder_ui_iframe#gf_2\">\n                        <label class='gfield_label gform-field-label' for='input_2_16'>\u0641\u064a\u0633\u0628\u0648\u0643<\/label><input name='input_16' id='input_2_16' type='text' value='' autocomplete='new-password'\/>This field is for validation purposes and should be left unchanged.<fieldset id=\"field_2_1\"><legend class='gfield_label gform-field-label gfield_label_before_complex'>Name(Required)<\/legend>\n                                                    <input type='text' name='input_1.3' id='input_2_1_3' value='' tabindex='2'  aria-required='true'   placeholder='\u0627\u0644\u0627\u0633\u0645 \u0627\u0644\u0623\u0648\u0644'  \/>\n                                                    <label for='input_2_1_3' class='gform-field-label gform-field-label--type-sub'>First<\/label>\n                                                    <input type='text' name='input_1.6' id='input_2_1_6' value='' tabindex='4'  aria-required='true'   placeholder='\u0627\u0633\u0645 \u0627\u0644\u0639\u0627\u0626\u0644\u0629'  \/>\n                                                    <label for='input_2_1_6' class='gform-field-label gform-field-label--type-sub'>Last<\/label>\n                        <\/fieldset><label class='gfield_label gform-field-label' for='input_2_3'>Email(Required)<\/label>\n                            <input name='input_3' id='input_2_3' type='email' value='' class='large' tabindex='6'  placeholder='\u0628\u0631\u064a\u062f \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <label class='gfield_label gform-field-label' for='input_2_4'>Phone(Required)<\/label><input name='input_4' id='input_2_4' type='tel' value='' class='large' tabindex='7' placeholder='\u0647\u0627\u062a\u0641' aria-required=\"true\" aria-invalid=\"false\"   \/><label class='gfield_label gform-field-label' for='input_2_5'>\u0645\u0648\u0642\u0639 \u0648\u064a\u0628<\/label>\n                    <input name='input_5' id='input_2_5' type='url' value='' class='large' tabindex='8'   placeholder='\u0645\u0648\u0642\u0639 \u0648\u064a\u0628'  aria-invalid=\"false\" \/>\n                <label class='gfield_label gform-field-label' for='input_2_6'>Date of incident(Required)<\/label>\n                            <input name='input_6' id='input_2_6' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='9'  placeholder='\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0648\u0627\u0642\u0639\u0629' aria-describedby=\"input_2_6_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            MM slash DD slash YYYY\n                        <input type='hidden' id='gforms_calendar_icon_input_2_6' class='gform_hidden' value='https:\/\/cyclistlaw.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><label class='gfield_label gform-field-label' for='input_2_7'>How crash occurred(Required)<\/label><textarea name='input_7' id='input_2_7' class='textarea small' tabindex='10'   placeholder='\u0643\u064a\u0641 \u0648\u0642\u0639 \u0627\u0644\u062d\u0627\u062f\u062b' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><label class='gfield_label gform-field-label' for='input_2_8'>Property damage(Required)<\/label><textarea name='input_8' id='input_2_8' class='textarea small' tabindex='11'   placeholder='\u0623\u0636\u0631\u0627\u0631 \u0628\u0627\u0644\u0645\u0645\u062a\u0644\u0643\u0627\u062a' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><label class='gfield_label gform-field-label' for='input_2_9'>Injuries complained of(Required)<\/label><textarea name='input_9' id='input_2_9' class='textarea small' tabindex='12'   placeholder='\u0634\u0643\u0627\u0648\u0649 \u0627\u0644\u0625\u0635\u0627\u0628\u0627\u062a' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><label class='gfield_label gform-field-label' for='input_2_10'>Injuries treated for(Required)<\/label><textarea name='input_10' id='input_2_10' class='textarea small' tabindex='13'   placeholder='\u0627\u0644\u0625\u0635\u0627\u0628\u0627\u062a \u0627\u0644\u062a\u064a \u062a\u0645 \u0639\u0644\u0627\u062c\u0647\u0627' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><label class='gfield_label gform-field-label' for='input_2_11'>Treating physicians(Required)<\/label><textarea name='input_11' id='input_2_11' class='textarea small' tabindex='14'   placeholder='\u0627\u0644\u0623\u0637\u0628\u0627\u0621 \u0627\u0644\u0645\u0639\u0627\u0644\u062c\u0648\u0646' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><label class='gfield_label gform-field-label' for='input_2_12'>Last date of treatment(Required)<\/label>\n                            <input name='input_12' id='input_2_12' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='15'  placeholder='\u0622\u062e\u0631 \u0645\u0648\u0639\u062f \u0644\u0644\u0639\u0644\u0627\u062c' aria-describedby=\"input_2_12_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            MM slash DD slash YYYY\n                        <input type='hidden' id='gforms_calendar_icon_input_2_12' class='gform_hidden' value='https:\/\/cyclistlaw.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><p><strong>\u0635\u0648\u0631 \u0630\u0627\u062a \u0635\u0644\u0629 \u0628\u062a\u0642\u064a\u064a\u0645 \u0627\u0644\u0645\u0633\u0624\u0648\u0644\u064a\u0629 \u0648\u0627\u0644\u0623\u0636\u0631\u0627\u0631<\/strong><\/p><label class='gfield_label gform-field-label' for='gform_browse_button_2_13'>\u0635\u0648\u0631 \u0630\u0627\u062a \u0635\u0644\u0629 \u0628\u062a\u0642\u064a\u064a\u0645 \u0627\u0644\u0645\u0633\u0624\u0648\u0644\u064a\u0629 \u0648\u0627\u0644\u0623\u0636\u0631\u0627\u0631<\/label>\n\t\t\t\t\t\t\t\t\t\t\tDrop files here or \n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_2_13' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_2_13\" tabindex='16'>Select files<\/button>\n\t\t\t\t\t\t\t\t\tAccepted file types: jpg, png, Max. file size: 50 MB, Max. files: 5.<ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_2_13'><\/ul> <label class='gfield_label gform-field-label' for='input_2_14'>\u062e\u0637\u0629 \u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u062d\u064a\u0627\u0629 \u0623\u0648 \u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0623\u062e\u0631\u0649 \u0630\u0627\u062a \u0635\u0644\u0629<\/label><textarea name='input_14' id='input_2_14' class='textarea large' tabindex='17'   placeholder='\u062e\u0637\u0629 \u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u062d\u064a\u0627\u0629 \u0623\u0648 \u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0623\u062e\u0631\u0649 \u0630\u0627\u062a \u0635\u0644\u0629'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea>\n         <input type='submit' id='gform_submit_button_2' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='\u064a\u064f\u0642\u062f\u0651\u0650\u0645' tabindex='18' \/> <input type='hidden' name='gform_ajax' value='form_id=2&amp;title=&amp;description=&amp;tabindex=1&amp;theme=gravity-theme&amp;styles=[]&amp;hash=cdc53c2d4de40974573188d4d10d30e0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_2' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_2' id='gform_style_settings_2' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' value='WyJbXSIsImZkYTQ3OTdjMWZlNDEwN2Q1ZmZiZTk1NWUyMDNhM2VmIl0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_2' id='gform_target_page_number_2' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_2' id='gform_source_page_number_2' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_2' value='' \/>\n                        <input type=\"hidden\" id=\"ct_checkjs_2dace78f80bc92e6d7493423d729448e\" name=\"ct_checkjs\" value=\"0\" \/><input name=\"apbct__email_id__gravity_form\"\n                    aria-label=\"apbct__labct__label_id_id__gravity_form\"\n                    type=\"text\" size=\"30\" maxlength=\"200\" autocomplete=\"off\"\n                    value=\"\"\n                \/><input type=\"hidden\" name=\"trp-form-language\" value=\"ar\"\/><\/form>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_2' id='gform_ajax_frame_2' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>","protected":false},"excerpt":{"rendered":"<p>Attorney Co-Counsel &#038; Referral Request Form Request Trial Counsel Services Contact information: lenore@cyclistlaw.com 512-386-8117 (call OR text) By appointment only. attorney Co-Counsel Request For lawyers wanting case counsel, please fill out the following confidential form: FacebookThis field is for validation purposes and should be left unchanged. Name(Required) First Last Email(Required) Phone(Required)Website Date of incident(Required) MM [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"default","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-1978","page","type-page","status-publish","hentry"],"featured_image_src":null,"_links":{"self":[{"href":"https:\/\/cyclistlaw.com\/ar\/wp-json\/wp\/v2\/pages\/1978","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cyclistlaw.com\/ar\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cyclistlaw.com\/ar\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cyclistlaw.com\/ar\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/cyclistlaw.com\/ar\/wp-json\/wp\/v2\/comments?post=1978"}],"version-history":[{"count":0,"href":"https:\/\/cyclistlaw.com\/ar\/wp-json\/wp\/v2\/pages\/1978\/revisions"}],"wp:attachment":[{"href":"https:\/\/cyclistlaw.com\/ar\/wp-json\/wp\/v2\/media?parent=1978"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}