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Keith Carlson | In Memorium
David Jenkins | Of Counsel
Richard Craig | Of Counsel
Farva B. Jafri | Of Counsel
George G. Leynaud | Of Counsel
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Our Attorneys
Jeff Bier
Keith Carlson | In Memorium
David Jenkins | Of Counsel
Richard Craig | Of Counsel
Farva B. Jafri | Of Counsel
George G. Leynaud | Of Counsel
Practice Areas
Bicycle Accident
Birth Injuries
Brain Injuries
Burn Injuries
Car Accidents
Construction Site Accidents
Dog Bite Injuries
Medical Malpractice
Motorcycle Accidents
Nursing Home | Elder Abuse
Pedestrian Accidents
Products Liability
Slip and Fall Accidents
Spinal Cord Injury | Paralysis
Trucking Accident
Wrongful Death
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Step
1
of
6
16%
Have you or a loved one been injured due to the actions of someone else?
*
Yes
No
Not Sure
Which of following categories best describes what happened?
*
Bicycle Accident
Birth Injury
Brain Injury
Burn Injury
Car Accident
Dog Bite
Medical Malpractice
Motorcycle Accident
Pedestrian Accident
Product Malfunction/Drug Interaction
Trucking Accident
Wrongful Death
Nursing Home or Elder Abuse
Construction Site Accident
Spinal Cord Injury or Paralysis
Slip and Fall
Something Not Listed
Has the injured person been seen by a medical professional?
*
Yes
No
Not Sure
Did the infant survive or pass away?
*
Yes
No
Not Sure
Has the injured person been diagnosed with a brain injury by a neurologist?
*
Yes
No
Not Sure
Has the injured person been admitted to a burn unit?
*
Yes
No
Not Sure
Has the injured person been advised by a medical professional (doctor/nurse) that malpractice was committed?
*
Yes
No
Not Sure
Do you know the name and manufacturer of the product/drug that caused the injury?
*
Yes
No
Not Sure
Was the resident of the facility ignored by staff, dropped, or abused by a fellow resident?
*
Yes
No
Not Sure
Was the injured person hurt away from home?
*
Yes
No
Not Sure
Are You are Relative of the Departed Person?
*
Yes
No
Please briefly describe the incident
*
First Name
*
Last Name
*
Phone
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Email
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Disclaimer
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