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Free Case Evaluation

If you would like to contact us regarding a potential claim, please complete the form below. It is important that you put as much information as possible in the form so that we can fully evaluate whether or not you have a potential claim. Alternatively, you may contact us by telephone toll free at (888) 833-8988 to discuss the particular facts of your case. However, it is usually best to submit the facts of your case in writing so that we can fully evaluate the information before responding. In most cases, you will receive a response from our office within 24 hours of submitting your claim.

 

 

* = Required Fields

Full name*
E-mail address*
Full address*
Telephone number(s)*
Are you currently being represented by an attorney?*
Please provide the specific date on which your accident or injury occurred.
Please provide the exact physical location where your accident occurred, e.g. at a four way intersection in Downtown West Palm Beach or at a hospital emergency room.
Please state in much detail as possible how your accident occurred.
If you have received medical treatment since your accident, please provide a full description of all such treatment including the specific names of the doctors from whom you received treatment as well as the results of any tests that have been performed, e.g. MRIs, x-rays.

Completion of this form does not constitute a contract of representation. Our office cannot and does not formally represent you unless and until you sign a formal Contract of Representation with our office. By simply submitting the above information, you have not hired our office to represent you and you specifically understand that our office will not take any steps to protect your claim until you have signed a Contract of Representation. By submitting this form to us for review, you acknowledge that you have read and understand the above statements, and you understand that we are not acting as your attorney until a Contract may be signed in the future.

 

 

 
Free Case Evaluation

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