ATTORNEY-CLIENT CONTRACT

Page * of *

This contract is between The Monsour Law Firm (“Attorney”) and,

(“Client”) of [City, State], to represent Client for damages arising out of a personal injury claim against whosoever may be liable for same; and whereas The Monsour Law Firm agrees to represent Client; it is agreed as follows:

1) The Monsour Law Firm agrees to represent Client in their cause of action for personal injuries to settlement or final judgment of Client's claims against any and all parties responsible for damages, subject to paragraphs 7 and 8 below.

2) Client agrees to pay as compensation for Attorney’s services on-third percent (33 1/3%) of all claims or recoveries from and against all sources, persons, or entities whether actually tried before a judge or jury or not, provided that such final conclusion is made prior to any appeal of the case. The percentages referenced in this paragraph will be calculated on and subtracted from the gross amount of any recovery obtained before any outstanding expenses, incurred by our firm or any referring firm, or other costs have been deducted. Your case may be referred to or handled jointly with another law firm with which our firm has selected to assist us in handling this matter. If so, this will not affect the amount of attorney's fees or expenses that will be deducted from your recovery, if any. Our firm will assume joint responsibility for your representation, and the division of the attorney's fees, between our firm, and the referring attorney(s) will be based upon that joint representation. Expenses include all monies incurred or fronted by The Monsour Law Firm to evaluate and advance your case. These include, but are not limited to, costs associated with: medical records, filing fees, copies, telecommunications, travel, expert witnesses, treating doctors, probate (when necessary), global settlement allocations, common benefit fees, common benefit expenses, lien resolution costs, liability discovery and any other area necessary for the prosecution of Client’s claim. 3) Client does not have to repay any expenses advanced or attorney’s fees should The Monsour Law Firm be unable to make a recovery for client.

4) If the Client’s claim includes reimbursement for medical expenses incurred in treating the injury made the basis of the claim, the Client may, by contract or statute, be required to repay to the party who paid the medical expenses part or all of those amounts (i.e. subrogation). This is the Client’s obligation, and such repayment, if any, shall be the Client’s responsibility and shall be paid out of the Client’s settlement proceeds. If a dispute arises between the Client and a subrogee or lien holder, the Client agrees to allow the attorney to hold the maximum amount being claimed in an escrow account until such dispute has been resolved. 5) The Monsour Law Firm is hereby authorized to bring suit when and in any matter they deem advisable; however, the consent of the above named client must be secured before any final settlement is made. Further, Client empowers attorney to take all steps in said matter deemed by attorney to be advisable, including but not limited to effectuating a compromise, institute legal proceedings and to take any other appropriate steps. Client specifically authorizes Attorney to settle their claim in the event Attorney cannot locate or communicate with Client to obtain Clients authorization to settle.

6) Client, hereby gives The Monsour Law Firm client’s power of attorney to execute all documents connected with the claim for the prosecution of which the attorneys are retained, including pleadings, contracts, checks or drafts, settlement agreements, compromises and releases, verifications, dismissals, and orders and all other documents which Client could properly execute.

7) Client hereby transfers and assigns to Attorney an undivided interest in Client’s claims. The undivided interest hereby assigned to Attorney by Client is equivalent to the fees, costs, and expenses, including the percentage of any recovery as defined in paragraph 2 above, that Client, by this agreement, promises to pay to Attorney. The undivided interest assigned by this agreement is a present, not an executory, interest.

+17

Wayne Aaron Reynolds

ATTORNEY-CLIENT CONTRACT

Page 2 of 3

8) The Monsour Law Firm may withdraw from the client's representation in this claim at any time, on reasonable written notice to the client at the client’s last known address. 9) Client understands that The Monsour Law Firm has made no representation concerning the successful termination of clients claim, or the favorable outcome of any legal action that may be filed, and has not guaranteed that he will obtain reimbursement to client of any of clients’ costs or expenses resulting from the incident out of which the claim arises. Client further expressly acknowledges that all statements of this law firm on these matters are statements of opinion only.

10) The State Bar of Texas investigates and prosecutes professional misconduct committed by Texas attorneys. Although not every complaint against or dispute with a lawyer involves professional misconduct, the State Bar Office of General Counsel will provide you with information about how to file a complaint. For more information, please call 1-800-***-****. This is a toll-free phone call. 11) YOUR DOCTORS WILL NOT BE SUED. Client understands that they may have a medical malpractice claim against the doctor(s) who prescribed the drug that caused their injury and/or who monitored their progress while treating with the drug; however, Client understands and agrees that Attorneys will not investigate a medical malpractice action or any other claim against Client’s doctor(s). Client also understands that the drug companies may blame Client’s doctors before or at trial. The jury may be asked to determine whether Client’s doctor(s) are at fault. If the drug companies’ attorneys convince the jury of the doctor’s fault, Client’s total recovery, if any, may be reduced by the portion of fault, if any, the jury places on Client’s doctor(s). Client understands that any claim or lawsuit against their doctor(s) must be filed with the Court and served upon the doctor(s) within the lawful time limit (statute of limitations). This time limit is different in each state, and no representation is made by The Monsour Law Firm as to whether, or how much, time remains before the legal deadline is reached to sue Client’s doctor(s). If Client desires to sue their doctor(s) and fails to timely file and serve such a lawsuit, Client will never recover any money, if any was ever owed, from Client’s doctor(s). Client understands that this statute of limitations may have already passed. Nevertheless, every day the doctors are not sued may be the last day a suit may be filed against them. Client understands that if they desire to sue their doctor, Client will need to retain other counsel, immediately, to investigate and possibly pursue such a claim. 12) SETTLEMENT PROCEDURE IN MULTIPLE CLIENT CASES. Frequently, drug companies may attempt to settle cases in groups under a matrix-type system whereby The Monsour Law Firm clients are offered different settlement amounts, depending on the circumstances of different groups of clients categorized by the severity of the injury and exposure to the drug. Once settlement value under the “matrix” is determined, Client is then given the opportunity to accept or reject the money being offered, within the matrix system, for whatever group within which the client may be placed.

Drug companies may, also, try to settle all or a portion of The Monsour Law Firm cases as a group, meaning the drug companies may attempt to settle Client’s case along with a number of other similar cases the firm is handling. When this “group settlement” system is being offered by a drug company, Attorneys will get each client’s authorization for a minimum, gross amount for which the client authorizes the firm to attempt to settle the client’s case. The Firm then adds up the total of all clients’ minimum, authorized settlement values and attempts to settle the group for at least the total of all minimum amounts authorized by all the clients. I hereby authorize The Monsour Law Firm, to engage in negotiations with the aim of reaching an agreement for an aggregate settlement of my individual claim along with the claims of others of the law firm’s clients for their own injuries against a Defendant. I understand that my claim will be evaluated for this settlement based upon my medical records and records documenting my prescription drug use. ATTORNEY-CLIENT CONTRACT

Page 3 of 3

I HAVE READ AND FULLY UNDERSTAND THE ABOVE CONTRACT SIGNED AND EXECUTED ON

THE MONSOUR LAW FIRM

Douglas C. Monsour Client(s)

Katy Krottinger

DOB (mm/dd/year)

SSN

08/20/2020

06/15/1970

Wayne Aaron Reynolds

06/15/1970

Wayne Aaron Reynolds

Wayne Aaron Reynolds 06/15/1970

Wayne Aaron Reynolds 06/15/1970

Text REQUEST FOR AND AUTHORIZATION TO

RELEASE HEALTH INFORMATION

PRIVACY ACT AND PAPER WORK REDUCTION ACT INFORMATION: The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of the Act. We may not conduct or sponsor, and you are not required to respond to, a collection of information unless is displays a valid OMB number. We anticipate that the time expended by all individuals who must complete this form will average 2 minutes. This includes the time it will take to read the instructions, gather the necessary facts and fill out this form. The execution of this form does not authorize the release of information other than that specifically described below.

The information requested on this form is solicited under Title 38 U.S.C. The form authorizes release of information in accordance with the Health Insurance Portability and Accountability Act, 45 CFR Parts 160 and 164; 5 U.S.C. 552a; and 38 U.S.C. 5701 and 7332 that you specify. Your disclosure of the information requested on this form is voluntary. However, if the information including the last four of your Social Security Number (SSN) and Date of Birth (used to locate records for release) is not furnished completely and accurately, VA will be unable to comply with the request. The Veterans Health Administration may not condition treatment, payment, enrollment or eligibility on signing the authorization. VA may disclose the information that you put on the form as permitted by law. VA may make a “routine use” disclosure of the information as outlined in the Privacy Act system of records notices identified as 24VA10P2 “Patient Medical Record – VA”, 08VA05

“Employee Medical File System Records (Title 38)-VA” and in accordance with the Notice of Privacy Practices. VA may also use this information to identify veterans and person claiming or receiving VA benefits and their records, and for other purposes authorized or required by law.

TO: DEPARTMENT OF VETERANS AFFAIRS (Name and Address of VA Health Care Facility) LAST NAME- FIRST NAME- MIDDLE INITIAL LAST 4 SSN DATE OF BIRTH NAME AND ADDRESS OF ORGANIZATION, INDIVIDUAL, OR TITLE OF INDIVIDUAL TO WHOM INFORMATION IS TO BE RELEASED PURPOSE(S) OR NEED: Information is to be used by the individual for: TREATMENT BENEFITS LEGAL EMPLOYMENT

OTHER (Please specify)

INFORMATION REQUESTED: Check applicable box(es) and state the extent or nature of information to be provided: HEALTH SUMMARY (Prior 2 Years)

INPATIENT DISCHARGE SUMMARY (Dates):

PROGRESS NOTES:

SPECIFIC CLINICS (Name & Date Range):

SPECIFIC PROVIDERS (Name & Date Range):

DATE RANGE:

OPERATIVE/CLINICAL PROCEDURES (Name & Date):

LAB RESULTS:

SPECIFIC TESTS (Name & Date):

DATE RANGE:

RADIOLOGY REPORTS (Name & Date):

LIST OF ACTIVE MEDICATIONS:

FLU VACCINATION (Dose, Lot Number, Date & Location): OTHER (Describe):

VA FORM

SEP 201*-**-****

Page 1 of 2

Reynolds Wayne Aaron 9905 06/15/1970

LAST NAME- FIRST NAME- MIDDLE INITIAL LAST 4 SSN DATE OF BIRTH SENSITIVE DIAGNOSES: REVIEW AND, IF APPROPRIATE, COMPLETE WHEN RELEASE IS FOR ANY PURPOSE OTHER THAN TREATMENT.

I request and authorize Department of Veterans Affairs to release the information pertaining to the condition(s) below for the non-treatment purpose(s) listed in this authorization.

DRUG ABUSE ALCOHOLISM OR ALCOHOL ABUSE SICKLE CELL ANEMIA HUMAN IMMUNODEFICIENCY VIRUS (HIV)

I understand that information on these sensitive diagnoses may be released for treatment purposes without me checking the above boxes, and will be released even if the boxes are unchecked unless I indicate by checking the box below that I do not want this information released for this specific disclosure.

I do not want sensitive diagnoses released for treatment purposes under this specific authorization. I realize this does not impact other future requests unrelated to this authorization. AUTHORIZATION: I certify that this request has been made freely, voluntarily and without coercion and that the information given above is accurate and complete to the best of my knowledge. I understand that I will receive a copy of this form after I sign it. I may revoke this authorization in writing, at any time except to the extent that action has already been taken to comply with it. Written revocation is effective upon receipt by the Release of Information Unit at the facility housing records. Any disclosure of information carries with it the potential for unauthorized redisclosure, and the information may not be protected by federal confidentiality rules. I understand that the VA health care provider’s opinions and statements are not official VA decisions regarding whether I will receive other VA benefits or, if I receive VA benefits, their amount. They may, however, be considered with other evidence when these decisions are made at a VA Regional Office that specializes in benefit decisions. EXPIRATION: Without my express revocation, the authorization will automatically expire. AFTER ONE-TIME DISCLOSURE, IF ALL NEEDS ARE SATISFIED ON (enter a future date other than date signed by patient) UNDER THE FOLLOWING CONDITION(S):

PATIENT SIGNATURE (Sign in ink) DATE (mm/dd/yyyy)

LEGAL REPRESENTATIVE SIGNATURE (if applicable) (Sign in ink) DATE (mm/dd/yyyy) PRINT NAME OF LEGAL REPRESENTATIVE RELATIONSHIP TO PATIENT FOR VA USE ONLY

TYPE AND EXTENT OF MATERIAL RELEASED

DATE RELEASED RELEASED BY:

VA FORM 10-5345, SEP 2018 Page 2 of 2

Reynolds Wayne Aaron 9905 06/15/1970

Contact this candidate