Waukegan Personal Injury Lawyers, Chicago Medical Malpractice Attorneys, Birth Injuries, Car Accidents

(877) 249-1227

Monday - Friday:
8:30AM - 5:00PM

Saturday:
9:00AM - 1:00PM

Sunday:
Closed

ACCIDENTS EVALUATION FORM

Title:
First Name:
MI:
Last Name:
Email Address:
Home Phone:
Street Address:
Apt/Suite:
City:
State/Zip:
Date of Accident:
City where Accident occurred:
State where Accident occurred:
Location of Accident?
Is an attorney currently representing you for this matter?	Yes No
How did accident occur?:
What injuries resulted from accident:
How did you hear about us?
I understand that by submitting this form I am not retaining a lawyer. Please know that you are not considered a client of our firm until your case has been accepted by us, and you have signed a formal "retainer agreement."

Areas We Serve: Aurora, IL, Cook County, IL, Joliet, IL, Naperville, IL, Waukegan, IL, Rockford, IL, Chicago, IL, Rock County, Illinois, Greene County, IL. Our Practice Areas: Medical Malpractice, Personal Injury, Birth Injury, Vehicle Accidents, Nursing Home Neglect, Misdiagnosis.