Ohio Gov. Bar. R. 3
Each attorney participating in a lawyer referral service may give written notice to his or her client informing the client that the attorney may be required to disclose to the service that referred the client certain information regarding the client's case. The notice shall describe the information that may be reported, including, but not limited to the current status of the client's case and the amount of the attorney's fee, and indicate that the disclosure is required in order for the service to satisfy its reporting requirements to the Supreme Court Office of Attorney Services. The notice shall be similar in substance to the following:
ACKNOWLEDGEMENT OF UNDERSTANDING
Pursuant to the reporting requirements set forth by the Supreme Court Office of Attorney Services, I understand and acknowledge that (insert Attorney's Name), my attorney, may be required to release and report to (insert name of the Lawyer Referral Service), the lawyer referral service that recommended my attorney's services to me, pertinent information regarding my case, which may include the current status of my case and the amount of the attorney's fees. I further acknowledge that by signing this document, the disclosure policy applicable to my case has been fully explained to me and that all of my questions have been answered regarding this matter.
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Client's Signature
Ohio. Gov. Bar. R. 3