The federal Family and Medical Leave Act (FMLA) allows eligible employees up to 12 unpaid weeks off from work when they are unable to work because of serious illness, or after the birth or adoption of a child, or to care for a spouse, child, or parent with a serious health condition.  If you believe your rights under this law have been violated by your employer, please take a few moments to fill out the form below.

At the end of the form, type the word yes in the last box and click “Submit.”

Completing this form does not create an attorney-client relationship. While the information you have provided is privileged and confidential, we do not represent you until we enter into a written agreement. We will review your submission based on the information you provide to determine whether you have a viable claim.