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PoA for Personal Care Intake Form

Fill out the information below. We'll take care of the rest. 

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Please read the privacy policy below, and then fill out this POWER OF ATTORNEY FOR PERSONAL CARE form in its entirety.

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 128-bit SSL encryption.

Your personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

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