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  • Phone: 1-800-560-2139

Have you been seriously injured in an accident?

Please fill out the form below so we can better understand your case and work with you to achieve the results you are entitled to. After submitting the form below you will be contacted by our firm within 24 hours. Should you require assistance before that time, please feel free to call us at 1-800-560-2139.

Name *
Email *
Phone *
Address *
City *
State *
Were witnesses present?
Have you seen a doctor?
Have you filed a claim?
Have you filed a police report?
Have you given a recorded statement? *
Did the at fault party have insurance? *
How did the incident occur? *
What type of injuries did you suffer? *
Additional Comments
Please Read Before Submitting your Message: Please note that any communication with our firm through this website does not constitute or create an attorney-client relationship with our firm. By clicking "Submit," you agree that we may review any information you transmit to us. You recognize that our review of your information, even if it is highly confidential and even if it is transmitted in a good faith effort to retain us, does not constitute or create an attorney-client relationship.