In order to obtain information
about your case, we need your authorization to release your case
documents and information to us. We cannot proceed without it.
Enter your ATTORNEY’S NAME HERE:
I hereby authorize and direct you, and/or your successors, to
release to Lawsuit Cash, and/or their successors, any and all
information, whether oral or otherwise, that pertains to my case
for the purpose of evaluating my claim. I also specifically
waive any privilege that I may have in this regard and request
that my attorney share his/her candid opinion of my case with
I understand that authorizing the disclosure of protected health
information is voluntary. I can refuse to sign this
authorization. I need not sign this form in order to assure
treatment. I understand I may inspect or copy the information
to be used or disclosed, as provided under HIPAA compliance
I acknowledge that I understand the benefits and costs of
non-recourse funding. I further acknowledge I understand the
effects of disclosing the contents of my file, including waiver
of the attorney-client and work product privileges and agree to
release Lawsuit Cash, and/or their successors fully and
completely from any claim that may arise by reason thereof.
Thank you in advance for your cooperation in this matter.
Enter your FULL NAME here:
Enter TODAY'S DATE here:
By clicking here you indicate that you have read and agree to
the Authorization for Release of Information. You must check
this box to have your application processed. This gives us
permission to contact your attorney and review your file. All
information is held strictly confidential.
By submitting this form I agree that all the information listed
is accurate to the best of my knowledge.