Car Accident Lawyers and Attorneys: Broken Bone?
We are associated with experienced auto accident attorneys who have experience handling all types of auto accident claims including serious fracture injury claims. The attorneys handle the case for no money up front, and then deduct their fee from the final settlement.
Contact us for a free claims evaluation.
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Title: |
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First Name: |
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M. I. |
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Last Name: |
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Address: |
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City: |
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State: |
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Zip Code: |
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Phone Number (day): |
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Phone Number (eve): |
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Email Address |
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Title: |
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First Name: |
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MI |
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Last Name: |
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What is the Injured's relationship to you?: |
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Injured's Date of
Birth? |
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Have you or they been been in an auto accident?: |
Yes No |
Date
of accident? (ie . mm/dd/19yy) |
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What city and state did the accident occur in? |
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What were your Injuries? |
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What type of medical treatment was received? |
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Who was responsible for the accident? |
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Was the person(s) injured wearing a seat belt? |
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Did the Police respond to the accident? |
Yes No |
Did anyone recieve a ticket? |
Yes No |
Did the other driver have insurance? |
Yes No |
Do you have insurance? |
Yes No |
Do your currently have an attorney? |
Yes No |
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I understand that submitting this form does not create an attorney client relationship: Agree |