Contact form for
Physicians & Lawyers
Dear Colleague: At Cloutier Law Offices, a substantial percentage of our cases come from referrals made by physicians, attorneys, insurance professionals, and others. We want to make it easy and convenient for you to refer your patient or client. You may always call, email, or text us to make a referral, but for your convenience you can complete these fields and we will reply quickly. We will honor your preference as to contacting you or the patient/client. If there is no impediment to doing so, we can arrange for a free consultation with your patient/client. The information you provide is confidential. Submitting this form is for information purposes only and does not create an attorney-client relationship with the person you are referring.
Thank you for trusting Cloutier Law Offices. Please fill out our consultation form so we can reach out to you.
* Indicates Required Fields. If you provide a telephone number, by clicking “submit” below you authorize us to call or text the number you provided.
Your information is confidential. Submitting this form is for information purposes only and does not create an attorney-client relationship. An attorney-client relationship is created if and when a written Representation Agreement is signed by you and the Firm. Normally, your inquiry will be responded to within 24 to 72 hours.
Cloutier Law Offices
17150 State Road 23
South Bend, IN 46635
574-271-4435 or
877-306-HELP (4357)
Fax: 574-271-1899