NO OBLIGATION CONSULTATION FREE!

Lawson Glod Mahoney offers a preliminary legal consultation in personal injury matters on a no obligation, no charge basis.

On receipt of the following information we will provide you with our opinion concerning whether you have a case and information on what you can recover, as well as our anticipated fee.

Please fill in the following form and submit it to us. All information is strictly confidential.

Boxes marked with a * are required. This will allow us to respond to your questions or concerns.

*Name:
*Address:
Email Address:
*Phone (including area code):
Date of Accident:
Location of Accident:
Name of Other Driver:
Tell us how the accident occurred (e.g. Who was driving, speed of vehicles, color of light etc.):
Did the police come to the scene of the accident?	............ Yes	............ No
Was anyone charged by the police?	............ Yes	............ No
Were you wearing your seatbelt?	............ Yes	............ No

Please describe the damage to your vehicle
What injuries did you suffer in the accident?
Have you been unable to work since the accident? If so what is your job and how long have you been off work?
Were you driving as part of your job duties at the time of the accident?	............ Yes	............ No

Name of your Insurance Company:
Name of other driver's Insurance Company:
Any additional questions you have:

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