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Car Accident Lawsuit Questionnaire

Would you like a free legal review of your potential car accident lawsuit?  All you need to do is fill out the simple form below. There is no commitment, and we will let you know if we can help you.

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Please complete the following questionnaire:

First Name:
Last Name: *
Home Phone: *
Work Phone:
Best time to call:
City and State:
Email:
Were you a:
If other, please describe:
Did you get the other driver's information?Yes
No
Do you have collision insurance?Yes
No
Date of Accident (mm/dd/yyyy):
Approximate Time of Accident:
Weather Conditions:
Location of Accident:
What are your Injuries?
Please describe the accident and how it happened:
Were photos taken of: Accident Scene
Injuries
Was the accident reported to the police?Yes
No
Were you hospitalized?Yes
No
Additional comments:


see also:

FREE Legal Review Report your Car Accident so that We Can Help.
Learn more about Reporting your Car Accident to our Lawyers

Research Center Need a Car Accidents Lawyer? Get a free legal review from an attorney
Find out from our lawyers about your rights after a car accident

Car/Auto Accident information Get a FREE Car Accident Lawsuit Case Evaluation and information
FREE Information on Car Accident Lawsuit from Weitz & Luxenberg


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$37 million verdict — 2 asbestos lung cancer plaintiffs

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$2.6 million settlement — ill-fitting prosthesis caused decubitus ulcers

$1.5 million settlement — construction worker fell off elevated train tracks

$750,000 settlement — defective construction equipment resulted in serious injury to worker



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A nationally-recognized personal injury law firm, Weitz & Luxenberg is committed to helping clients win cases, get the compensation to which they’re entitled and continue with their lives. In just over 20 years, we’ve collected more than $1.3 billion for plaintiffs.