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Dennis A. Lopez, P.A. & Associates
210 North Pierce Street
Tampa, FL 33602
Phone: 866-640-9399

What type of injuries do you have?

Auto/Motor Vehicle Accident
Slip and fall
Dog bite
Railroad accident
Wrongful death
Hurt on the job
Other

What is the extent of your injuries?

Have you seen a doctor?

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What are your medical bills?

Have you filed any claims?

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Have you filed a police report?

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No

Were there any witnesses?

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No

Do you have insurance that covers you for this type of incident?

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No
Not Sure

Do other involved parties have insurance that covers this type of incident?

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No
Not sure

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