Lawyer and attorney for a personal injury accident from Indianapolis and Fort Wayne

Case Evaluation

Please fill out the following for a free case review. The information submitted will be accorded the utmost confidentiality. This information is necessary in order to do a conflict of interest check before responding to you. If you prefer, you may contact us at (317) 636-8636 or toll free at (800) 266-LAWS.

Please provide the following information for the person in need of assistance. Fields with (*) are required.

*Full Name

*Date of Birth

*Full Address

*E-Mail

Phone

Please provide an overview of the legal matter you need assistance with.

Injury Cases

If you need assistance with an injury matter (including wrongful death claims, product liability claims and malpractice claims) please submit the following information as well.

City and State in which you were injured.

Please describe your injuries.

Please describe any treatment you are presently receiving or have received for your injuries.

What is the approximate amount of your medical bills thus far?

If you have missed work due to your injuries, how much in lost wages and/or benefits have you sustained?

If you are currently represented by another attorney, please provide the attorney’s name, address and phone number.

If You Are Not The Injured Party

If you have filled this information out for someone else, and are not the person in need of assistance, please answer the following:

Full Name

Home Phone

Relationship to the person in need of assistance (e.g. parent, spouse, friend)

After the information is complete, please press the submit button. We will review the information and contact you as soon as we have done a conflict of interest check.

Airplane Accidents Boating Accidents Cerebral Palsy Spinal Cord Injury Medical Malpractice Construction Accidents DUI Law Motor Vehicle Accidents Traumatic Brain Injury Hazardous Products Tort Drug Litigation Personal Injury Premises Liability Railroad Accidents Wrongful Death Nursing Home Abuse	Case Evaluation Please fill out the following for a free case review. The information submitted will be accorded the utmost confidentiality. This information is necessary in order to do a conflict of interest check before responding to you. If you prefer, you may contact us at (317) 636-8636 or toll free at (800) 266-LAWS. Please provide the following information for the person in need of assistance. Fields with () are required. Full Name Date of Birth Full Address *E-Mail Phone Please provide an overview of the legal matter you need assistance with. Injury Cases If you need assistance with an injury matter (including wrongful death claims, product liability claims and malpractice claims) please submit the following information as well. City and State in which you were injured. Please describe your injuries. Please describe any treatment you are presently receiving or have received for your injuries. What is the approximate amount of your medical bills thus far? $ If you have missed work due to your injuries, how much in lost wages and/or benefits have you sustained? $ If you are currently represented by another attorney, please provide the attorney’s name, address and phone number. If You Are Not The Injured Party If you have filled this information out for someone else, and are not the person in need of assistance, please answer the following: Full Name Home Phone Relationship to the person in need of assistance (e.g. parent, spouse, friend) After the information is complete, please press the submit button. We will review the information and contact you as soon as we have done a conflict of interest check.