L About Our Firm Practice Areas Home Page Landmark Cases Contact Us
   
Practice Areas
Medical Malpractice
Nursing Home Abuse & Neglect
Automobile Accidents
Catastrophic Injuries
Construction Accidents
Criminal Defense
Defective Products
Government Liability
Premises Liability
Construction Accident Inquiry Form
Title: First Name: MI: Last Name:
E-mail Address:
Retype E-mail:
Home Phone:
 - -
Mobile Phone: - -
Work Phone: - - ext.
   
   
Street Address:
Apt/Suite:
City:
State/Zip: /

What is the best way to reach you?
Please provide the best place, time and method for contacting you.
Injured Person Information
Date of Birth:  
Whom are you inquiring on behalf of?  
What is your relationship to the Injured person?
Is the person deceased? yes no  
If deceased, the cause of death
as stated on the death certificate:
Date of Death:  
Was there an autopsy performed? yes no  
Construction Accident Case Information

Employer's Name and Address:

List All Sub Contractors and General Contractors Involved:
How Did Accident Happen?:
  
Tell Us About Your Injuries:
  
Are You Disabled? Yes No  
Lost Earnings or Rate of Pay:  
Last Date of Work:  
Disclaimers:

Yes No - I agree that this matter may be referred to an attorney in my area who may contact me.

Yes No - I agree that by submitting this question, I will not be charged for the initial response. I understand that I am forming only a semi-confidential relationship.

Yes - I agree that the above does not constitute a request for legal advice and that I am not forming an attorney client relationship by submitting this question. I understand that I may only retain an attorney by entering into a fee agreement, and that I am not hereby entering into a fee agreement. I agree that the information that I will receive in response to the above question is general information and I will not be charged for the response to this e-mail question. I further understand that the law for each state may vary, and therefore, I will not rely upon this information as legal advice. Since this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter.


By Clicking the appropriate box below, I agree to:

or

  		 
December 27, 2007 11:36 PM

Serving all of New York State with experience in the Federal courts and State courts covering the counties of Albany, Brooklyn, Dutchess, Orange, Rockland, Sullivan, Ulster, Greene, Columbia, Rennselaer, Washington, Saratoga, Fulton, Montgomery, Nassau, Suffolk, Warren, Essex, Clinton, St. Lawrence, Onandoga, Erie, Broome, Delaware, Otsego, Oswego, Hamilton and Westchester
Call Us Toll Free 1-877-ABCDLAW (222-3529)
 206 Wall Street, Kingston, NY 12402 | 125 Wolf Road, Albany, NY 12203