Attorneys

When did the injury occur?

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

Please explain the nature & extent of your injuries?

Have you been to a hospital or seen a doctor?

Yes
No

Approximately what are and how much are your medical bills?

Have you filed any claims?

Yes
No

Have you filed a police report?

Yes
No

Were there any witnesses?

Yes
No

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

Yes
No
Not Sure

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

Yes
No
Not sure

Please explain why you think someone else is at fault for causing your injuries.

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