PERSONAL INJURY QUESTIONNAIRE:

Name:

Phone:

Address:

Email 

Date of Accident:

Type of Case:

Motor Vehicle Accident

Product Liability

Slip and Fall

Premises Liability

Medical Malpractice

Wrongful Death

Other

 Has suit been filed (if so, court and case number)

 Do you currently have an attorney?

 Were you hospitalized?

Were you seen at an emergency room?

 Part(s) of body injured.

 Brief description of accident, including who you believe to be at-fault and why.