Personal Consultation Form

The first thing your lawyer will need is information about you and your claim. Below is a form which you can email us to help us get to know you and how we can help.

* required fields.

About You

Please leave blank:

Name:	*
Address:	*
City:
Province:
Postal Code:
Email:
Home Phone:	*
Work Phone:
Cell Phone:

About Your Accident

When did it happen? *

Where did it happen?

A brief description of what happened.

How much damage was there to your car?

About the Affects on Your Life

How have the injuries affected you at work or school?

How have the injuries affected your ability to care for your home or family?

How have the injuries affected your recreational and social activities?

Disclaimer

Please note that there are time limitations for all injury claims. In order to protect your rights we must be hired to act for you. This form is the first step in the process and does not yet mean you have hired us to work for you. If your accident was more than 18 months ago call us immediately.

I have read and understood this disclaimer *

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