Salutation
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Mr.
Mrs.
Ms.
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Full Name
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Phone
Email
Lead Medium
Lead Medium
Chat
Call
Email
After Hours Call Center
Other
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Source / Campaign
AVVO
Facebook
GMB*
LSA*
PPC*
Referral (Identify Referral Partner Below)
SuperLawyers
Video Ad*
Website*
YouTube
MBA-C
Unknown
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Case Type
MVA
MedMal
PI - General
Wrongful Death
Nursing Home Neglect
Products Liability
CPAP
Criminal
Family
Business Matters
Other
Dental Med Mal
Mold
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Assigned User
Alec Mesrobian
Ryan Weigand
Jeremy Zelken
Jill Cuvala
Michael Phillips
Stephen J Phillips
Will Hapeman
Unassigned
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Should we send a message to the lead acknowledging receipt of the inquiry?
Yes
No
Lead Score
1
2
3
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Lead's Street Address
City
State
ZIP
How should we classify this lead:
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Declined
Open
Won
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Where should we send this lead:
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New Lead
Engaged
Referred
Declined
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Who referred this lead to PLO
None/ Unknown
Former/ Existing Client
Appel, Brendan
Canna, Matthew
Catrambone, Greg
Disparti, Larry
Heres, Tom
Konicek & Dillon
Phillips, Steve
Phillips, Stephen
Quinn, Terrence
Ryan, Philip
Tripplett, Jeff
Other
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Date of Incident
Notes
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