Office of Disciplinary Counsel - Grievance Form

Date of this form

Your Contact Information

Salutation Last Name First Name Middle Initial Street Address City State ZIP Code County Phone Alternate Phone Email Preferred Method of Correspondence:

Email U.S. Mail

Are you an Ohio attorney or judge?

Yes No

About Whom Are You Complaining?

Entity Type

Judge/Magistrate Attorney UPL

Last Name First Name Middle Initial Registration Number

(Can be found at https://www.supremecourt.ohio.gov/attorneysearch/#/search)

Name of Office/Firm Office Address City State ZIP Code County Phone Alternate Phone Email

Legal Matter

Bankruptcy

Juvenile

Real Estate

Corporation/Partnership

Criminal

Family (Divorce/Support/Custody)

Estate/Probate/Trusts

Social Security

Immigration/Naturalization

Employment Law

Landlord/Tenant

Personal Injury

Workers’ Compensation

Adoption

Other

Additional Information

Have you filed this grievance with any other entity?

Yes No

If Yes, provide entity: Date Filed: Does this matter involve a court case?

Yes No

1. If Yes, provide name of court: Full Case Number: 2. Have your concerns been raised with the court?

Yes No

3. If Yes, provide date and the outcome: If your grievance is against a lawyer, describe your relationship to the lawyer who is the subject of your grievance:

Client Former Client Opposing Counsel Opposing Party Judge Other: If Other:

If a client or former client, provide the following:

1. Date representation began: 2. Did you pay this attorney?

Yes No

If Yes, how much: 3. Did you sign a written fee agreement?

Yes No

If Yes, please attach a copy of the signed fee agreement: 4. Has the attorney sued you for fees?

Yes No

5. Does the attorney still represent you?

Yes No

6. Is the matter ongoing?

Yes No

7. Date of last contact with the attorney: If you have obtained new counsel, please provide name: ...and phone: What action or resolution are you seeking from this office? Witnesses – Please provide name(s), address, and phone for each:

Facts of the Grievance

Please describe what the attorney or judicial officer did to violate professional obligations.

Acknowledgment

All information on this form is true and correct

I have read the grievance instructions

I am the individual whose contact info appears on the form

I agree to maintain the confidentiality of this grievance

Signature (type your full name) Date