Case Evaluation

Please fill out the following information for a case review.  Once it is submitted, a member of our staff will contact you to schedule a consultation appointment with an attorney.  A free consultation is available for all contingency fee based cases, such as personal injury, wrongful death, etc.  All other types of cases require an initial consultation fee, which will be determined by the Attorney you are meeting with.

All information submitted will be accorded the utmost confidentiality. This information is necessary in order to do a conflict of interest check before responding to you. If you prefer, you may contact us at (239) 774-2229.

Please provide the following information for the person in need of assistance. Fields with (*) are required.

*Full Name

*Date of Birth

*Full Address

*E-Mail

Phone

Please provide an overview of the legal matter you need assistance with.

Injury Cases

If you need assistance with an injury matter (including wrongful death claims, product liability claims and malpractice claims) please submit the following information as well.

City and State in which you were injured.

Please describe your injuries.

Please describe any treatment you are presently receiving or have received for your injuries.

What is the approximate amount of your medical bills thus far?
$

If you have missed work due to your injuries, how much in lost wages and/or benefits have you sustained?
$

If you are currently represented by another attorney, please provide the attorney’s name, address and phone number.

If You Are Not The Injured Party

If you have filled this information out for someone else, and are not the person in need of assistance, please answer the following:

Full Name

Home Phone

Relationship to the person in need of assistance (e.g. parent, spouse, friend)

After the information is complete, please press the submit button. We will review the information and contact you as soon as we have done a conflict of interest check.

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