Retaining Chicago’s Behn & Wyetzner

At Behn & Wyetzner, our attorneys have dedicated their careers to prosecuting fraud, protecting employees’ rights, and zealously representing whistleblowers who have the courage to come forward. We can help you because we focus exclusively on the problems faced by whistleblowers. For a quarter of a century, we have achieved dramatic results for our clients.

To arrange for a consultation with one of our attorneys about a potential case, please fill out our questionnaire or contact us via phone at 312-629-0000.

Behn & Wyetzner, Chartered

10 North Dearborn Street, 6th Floor
Chicago, Illinois 60602

Phone: (312) 629-0000
Fax: (312) 629-0000

Qui Tam Whistleblower Questionnaire

We value your privacy. In order to protect your personal information from eavesdropping or data tampering, Behn & Wyetzner takes careful measures, using an encrypted connection that ensures that your private information can travel between our web server and your web browser.

However, total security and confidentiality of anything submitted via the internet cannot be guaranteed. If concerned, please print out the completed form and mail it to us.

IMPORTANT: Before completing this form, please review our Checklist for Potential Relators.

Part A - About You
Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Current Employer
Employer's City & State
Your Job Title/Position
Part B - About the Fraud
Name of the company that you believe is involved in the fraudulent activity:
Please describe the acts or activities that are fraudulent and identify how long the fraud has been going on.
Do you have any documentation of the fraud? If so, please describe.
Have you reported the fraud to anyone? If so, to whom did you report it, when, and what was their response?
If you had additional documentation or pages to include, please upload here.
Max. file size: 50 MB.
Important Disclaimer – Please Read Carefully

Please remember that submitting this form does not mean that Behn & Wyetzner has agreed to represent you. We do not represent you and do not have an attorney-client relationship until we enter into a written agreement.

Due to the demands of our practice, we cannot respond to every inquiry. If we do not respond to your inquiry within three business days, please assume we cannot represent you and promptly seek other counsel to protect your rights.

We will limit distribution of information you provide to our firm and co-counsel, for the purpose of evaluating your case. You authorize us to share all documentation and information you provide in this questionnaire and subsequent communications, including our work product regarding this submission, with DiCello Levitt Gutzler LLC, Howard Law LLC and any other experienced law firms and/or lawyers who may work on your case, at our sole discretion.

We will review your submission based on the information you provide to determine whether you have a viable claim. Our decision whether to accept your case will be based on a thorough investigation of the facts and the law.

You may be contacting us about matters that we are already working on, or provide information about matters we work on in the future. We cannot promise that information we learn from you will not be relevant to our consideration of other matters. Accordingly, we must condition our evaluation of any information you provide on your agreement that the confidentiality of the information you communicate will not be maintained except as specifically provided by this Disclaimer.

As with any legal matter, the passage of time may adversely affect your ability to assert your claims. Our investigation can be time consuming because we must analyze the facts and applicability of the False Claims Act to your specific potential claims.

The statute of limitations for the False Claims Act can be as short as six years, and the limitations period for employment claims can be substantially shorter. There is also a “first to file” rule under the False Claims Act, meaning that if someone files a complaint on the same subject matter as yours before you do, your case may be dismissed.

If our time frame for evaluation does not fit your needs, or you have any other disagreement with the terms of this disclaimer, please seek other counsel.
Acceptance of Terms
After reviewing the Checklist for Potential Relators and all of your responses above, please sign and date below to indicate your acceptance of these terms. Thank you for your inquiry.
Name
First Last
Date (MM/DD/YYYY)
I understand the terms of this disclaimer before proceeding*
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Qui Tam Whistleblower Questionnaire

Part A - About You

Part B - About the Fraud

Important Disclaimer – Please Read Carefully

Acceptance of Terms