Civil Litigation
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| 1. Is this for you or someone else? | ||||||||||||||||||||||||||||
| Myself | Family | Friend | Client | Other | ||||||||||||||||||||||||
| 2. Date of Accident: | ||||||||||||||||||||||||||||
| 3. City where accident occured: | ||||||||||||||||||||||||||||
| 4. State where accident occured: | ||||||||||||||||||||||||||||
| 5. Please briefly explain the incident that caused the injury: | ||||||||||||||||||||||||||||
| 6. Who do you believe was at fault in causing the injury, and what do you believe they did wrong? | ||||||||||||||||||||||||||||
| 7. Describe the injuries in detail: | ||||||||||||||||||||||||||||
| 8. Do you believe the injuries are permanent? | ||||||||||||||||||||||||||||
| Yes | No | |||||||||||||||||||||||||||
| 9. Please explain exactly what happened, trying to state as thoroughly as possible who you believe was responsible and why you believe that person was negligent: | ||||||||||||||||||||||||||||
| 10. Please explain the full extent of the victims injuries: | ||||||||||||||||||||||||||||
| 11. Is there anything else that would assist us in understanding the facts of your case? | ||||||||||||||||||||||||||||
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