Personal Injury Contact Form

*Name:

*Street Address:

*City:

*State:

*Zip:

*Home Phone:

*Work or Cell Phone:

*Email Address:

When were you injured?

How did the accident/injury happen?

Where did the event occur?

Was the accident/injury work-related? YesNo

Did you discover the injury after the incident or accident? YesNo

Was an investigation conducted (police or otherwise)? YesNo

When did you first receive medical care for your injury?

What was your diagnosis?

What treatment have you received?

Winckler & Harvey, L.L.P. Privacy Policy

It is our policy to respond to all persons making inquiries concerning personal injury matters. In the event that we are not able to contact you via the email address or telephone number(s) you have given us, we will contact you through the mail. Your privacy is very important to us. All information that persons making inquiries provide us will be kept in complete confidence by our firm attorneys and staff. We do not make the information you give us public in any way nor would we ever sell it.

Disclaimer: Contacting Winckler & Harvey, L.L.P. via this website does not constitute an obligation for Winckler & Harvey, L.L.P. to investigate or prosecute a claim. Such an obligation only arises when an attorney retainer agreement has been executed.

The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for individual advice regarding your own situation.