Phone: (203) 374-3992
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CAUTION:  THIS IS NOT A SECURE WEBSITE.  DO NOT FILL OUT THIS FORM ONLINE.  PRINT IT OUT, AND BRING IT WITH YOU WHEN YOU COME TO OUR OFFICE.

Name
Address
Phone
Email 
Date of Accident
Brief description of what happened
Were police called?
Yes   No 
What type of injuries did you receive?
Did you go to the hospital?
Yes   No 
Have you started to treat with anyone?
Yes   No 
Whom?
Did you lose time from work?
Yes   No 
Did you have health insurance to cover your medical bills?
Yes   No 
If an automobile accident, did you have an automobile insurance policy of your own in effect at the time of the accident?
Yes   No    Not an automobile accident 
If an automobile accident, about how much damage was there to your vehicle?

  

A lawyer is generally paid for his services in an accident case, which is also called a tort or negligence case, based on what is called a contingent fee arrangement. This is for most cases, one-third of what the lawyer recovers for the client. A lawyer is also reimbursed for the costs he incurs on behalf of the client. The law requires that, if our office represents you for an accident, we must have you sign a written retainer agreement, explaining the fee arrangement.

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