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Some answers to your questions.

Understand the importance of sound advice.

Title:
Name:*
Address:
City:*
Postal Code:
Phone:*
E-mail Address:
Age:
Referred By:
Parties Involved:
When did your injury occur? (Notice of claim must be provided to the Defendant within 120 days of the incident; to own insurer within 7 days)
How was the injury caused? Provide as much detail as you can. Include your view with respect to who is at fault.
What is the nature of your injuries?
Be as detailed as possible.
Have you returned to work?: Yes   No
If so, when?:
What kind of work do you do?
What is your annual income?: $
What continuing problems are you experiencing?
Have you applied for accident benefits?
For other benefits?
What accident benefits have you received to date?
What other benefits have you received to date?
What is the shortfall there between your income and benefits paid?
What is your insurer's name?
What evidence do you have of your income from all sources for the year preceding the incident?
What medical reports do you have? In the event that we agree to represent you we will require every medical report obtained as a result of this incident.
Can you provide a list of the names, addresses and telephone numbers of all hospitals, doctors, etc., who have treated you as a result of this incident?
Do you have a police report?: Yes   No
If a death was involved and an autopsy performed, provide the date and place of the autopsy and the name, address and telephone number of the doctor who performed the autopsy.
Were you referred
to a specific lawyer?:
Additional Comments