If you sustained a serious injury, please complete and submit the form below.

1. Name*
2. Email*
3. Phone
4. Date of Accident
5. Location of Accident (Please include City or Town, and State)
6. Describe Your Accident (Please include a description of what caused your accident, and who was at fault.)
7. Describe Your Injuries & Treatment
8. For motor vehicle accidents, describe the damage to the vehicles
9. Did the police respond to your accident?
10. Yes No
11. If so, do you have a police report?
12. Yes No
13. Were you examined or treated at a hospital emergency room?
14. Yes No
15. Were you hospitalized?
16. Yes No
17. Did you see a doctor as a result of your injuries?
18. Yes No
19. How long after the accident was your first medical or hospital examination or treatment?
20. Are you currently under a doctor's care for injuries sustained in this accident?
21. Yes No
22. How much time, if any, did you lose from work or school?
23. For security purposes, please answer the question below
24. 7+1

 

*Required

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Notice: Your submission of this form, or a free telephone consultation, will not constitute an attorney-client relationship.

New York Personal Injury Attorney Disclaimer: The New York personal injury, accident, injury, serious accident, or other personal injury legal information contained in this website is not intended to constitute legal advice, nor to create an attorney-client relationship or lawyer-client relationship. We recommend that you discuss your accident case with a New York Personal Injury Attorney or New York Accident Lawyer promptly, since there are strict time limitations that apply to New York personal injury litigation. This website is not intended to solicit clients for accident cases outside of New York State. Under New York law, in the event there is no recovery in a contingency fee case, the client is responsible for the expenses of the litigation, including court costs and disbursements.

New York Personal Injury Lawyers and Attorneys New York representing accident victims who have sustained serious injuries in New York City, Manhattan, Bronx, Brooklyn, Queens, Staten Island, Long Island, Nassau County, Suffolk County, Westchester County, Rockland County and upstate New York.