Construction Accident Case Intake Form
Section1
I was a(n):
Section2
The incident was reported to police:
section3
The incident was reported to my supervisor
After the accident, I sought medical or hospital care:
I injured my:
section4
The injuries have caused me to:
section5
I understand that the transmission of this information does not create an attorney client relationship but is, instead, a request for a free consultation with an attorney about the details of my potential case.