Please note: We have created an abbreviated intake questionnaire to help us begin thinking about your potential case. Of course we will go into more detail with you directly, but this will help to start the dialogue. Also, we have found that by beginning the process it helps one to not feel so isolated and alone.
Please do not worry if you cannot answer all of the questions; just do the best you can.
2. Briefly explain what happened.
3. Briefly describe your injuries.
4. Have you sought any diagnosis or treatment for your injuries?
(Doctor, chiropractor, hospital, acupuncturist, surgeon, osteopath, therapist, etc., or x-rays, MRI, cat scan, etc.)
5. Have you suffered any financial loss as a result of the accident/incident?
(Loss of job, loss of income and/ or benefits, medical bills, additional household help, etc.)
6. Do you know if the other person(s) has/have any insurance?
7. Have any other people been discriminated against, or might have been discriminated against?
Were they of the same protected class as yourself? (See question above.)
8. Did you report the accident/incident to anyone, or did anyone come to the scene?
Whom? Is there a report? Were there any witnesses?
Please fill out the form below to send us your responses in as a secure e-mail message. Again, all information you provide will be maintained in strict confidence. We will respond to your inquiry within 24 hours. Fields marked with an * are required.
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