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Contact — Personal Injury/Liabililty
Use the CONFIDENTIAL form below for a FREE evaluation of your legal needs. Submission of this form does not constitute an attorney-client relationship between you and the firm. One of our legal specialists will follow up by phone or email.
Note: Fields marked by an asterisk (*) must be completed.
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*First Name:
*Last Name:
Street Address:
*City:
*State:
Zip:
*Daytime Phone:
*Evening Phone:
E-Mail Address:


*Age of Person Involved:
 


*Do your legal needs involve:
   Auto accident
 Truck Accident
 Medical malpractice
 Aviation accident
 Unsafe or defective vehicle
 Dangerous or defective product
 Workplace injury (Worker's Compensation)
 Construction site accident
 Claim denials by insurance companies
 Injury due to medication
 Injury due to defective children's product
 Nursing home abuse or neglect
 Fall due to unsafe conditions
 Other


*Date of Accident/Injury:
 


List All Possible People/Parties Responsible For Injury
*1:
2:
3:


*How did you find Hourigan, Kluger & Quinn?