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Motor Vehicle Accidents Contact Form

A motor vehicle accident can have a devastating impact on you and your family. If you or a loved one has been injured, contact our firm to schedule a consultation with an experienced personal injury attorney.

Information About Motor Vehicle Accidents

Our lawyers provide aggressive and caring representation to clients who were injured in motor vehicle accidents. Most people are confused and worried when they come to our office, wondering how they will pay their medical bills or get the car fixed. By the time they leave our office, they are reassured and know that we will stand by them as long as necessary to obtain the compensation they need.

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Motor Vehicle Accidents Contact Form

*First Name

*Last Name

*Email Address

*Phone Number

*Zip

Street Address

Apt/Ste

Incident Street Address

Incident Apt/Ste

*Incident Zip

When and where did the accident occur?

What were the conditions? Light/Dark? Wet/Dry? Snow/Ice?

Where were you in the vehicle? Were you driving?

Who owns the vehicle?

Is the vehicle insured?
Yes  No 

Please describe how the accident happened.

Did the police come to the scene of the accident?
Yes  No 

If so, do you have a copy of the police report?
Yes  No 

Were any citations issued or arrests made?

Do you believe that alcohol was a factor in causing the accident?

Were you injured in the accident?
Yes  No 

Were you taken to the hospital?

What medical treatment have you received?

Are you currently receiving medical treatment?
Yes  No 

Was the other driver injured?
Yes  No 

Were any passengers injured?
Yes  No 

Please list any other concerns.

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