Lawvue
Personal Injury Questionnaire

If you have been injured as a result of an automobile accident, a product which is defective, the error of a doctor, attorney or other professional, a bite from an animal at large, a slip and fall or other incident for which you were not responsible, please fill out the following questionnaire. A Lawvue attorney will promptly respond with an opinion concerning your case and your prospects of recovery.

THESE TYPES OF CASES ARE GENERALLY HANDLED ON A CONTINGENT FEE

Please submit the following information. CAUTION: Be sure that your phone numbers and email address are correct. Otherwise we will not be able to contact you.

Name
Address Line 1
Line 2
City, State, Zip
Your home phone number with area code
Your daytime phone number with area code
Best time of day
to call you
E-mail address
The date in which the incident which caused your injury occurred
The place at which the injury occurred
A description of the incident which resulted in your injury
A description of the injuries which you sustained
The name of the other party (This is required to ensure that no conflict of interest is present)
Have you consulted with, or retained, another attorney? Yes    No
If so, set forth the name of the other attorney(s)

Thank you for taking the time to fill out this form. Please click on the "Submit" button below.
After submitting the information you will be directed to the Lawvue Home Page.
A Lawvue attorney will personally review your case and respond by email or telephonically.