Go to Top

CASE EVALUATION FORM

First Name: *   Last Name: *
 
     
Email: *    
   
     
Phone:    
Please provide your daytime phone number so we can contact you if we need additional information to complete your free case evaluation.
Day Phone *   Cell Phone
 
     
Your Address Information:
     
City: *   State: *
 
     
Date of injury   State where injury occurred
 
     
Do you currently have a lawyer?   Have any counsel rejected this case?
Yes No   Yes No
     
What type of injuries did you experience?
     
What is the best time/method to reach you? 
     
Please select an inquiry type from this list 
 
Please state your question: *
     
DISCLAIMER and STATEMENT OF NON-CONFIDENTIALITY
Information sent to Pachtman Law Office using this form is protected using standard Internet encryption technology. We will treat this information confidentially; however, submitting this information does not create an attorney-client relationship of any kind. The information on this site is not meant as legal advice nor does it constitute an offer to represent you.
     
     
   
     

 

 

Toughlawyers.net is made available as a service to our clients and friends. Articles contained here should be viewed as general commentary on the law and not as substitutes for legal counsel. You should not act on information contained herein without further legal consultation. If you have specific legal questions or needs, please call us at 610.859.3700 to talk with us at no charge, or send us an e-mail.
Copyright © 2000 - 2015 Pachtman Law Office, All Rights Reserved