CONTACT US

Who do you believe was at fault, and what do you believe they did wrong?

Do you have any other information which you believe would help us help you?

Describe your injuries, losses or damages. If you know, state whether you have a permanent injury. If you know, what are your total medical bills to date?

Have you lost any earnings? Are you still off work? What kind of work do you do, and how much do you earn per week or per month?

Have you suffered any other losses because of this incident and, if so, please describe your losses:

Were you married when the incident occurred and, if so, has your spouse suffered any loss or damage because of the incident?

Have you contacted any other lawyer about your potential claim and, if so:

• Did the lawyer agree to represent you? Yes No
  
• Are you still being represented by the lawyer? Yes No
  
• Are you now seeking a lawyer to represent you, or are youjust looking for a second opinion?
  
  
• Do you owe any other lawyer a fee in this matter? Yes No
  
• If we are willing to represent you, do you wish to employ us? Yes No

Have you negotiated with any insurance company or any other person in connection with this claim and, if so:

• Are negotiations still ongoing? Yes No
  
• What was the lowest settlement amount that you asked for?
  
  
• What was the highest amount that you have been offered to settle?
  
  
• Have the medical or funeral bills or lost wages been paid for by:
  Workers Compensation?
  Medicare, medicaid, or some other government program?
  Employer's health plan?
  Private insurance?
  
  
• Are there any other questions you wish answered?
  
  
• Is there any other information that you want to provide us?
  
  
• Would you like to arrange a personal interview? Yes No
  
• Are there any other instructions you wish to give us?