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Construction Accident Intake

Construction Accident Case Intake Form

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I was a(n):


The incident was reported to police:


The incident was reported to my supervisor

After the accident, I sought medical or hospital care:

I injured my:


The injuries have caused me to:


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.