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Case Intake Forms

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Construction Accident Case Intake Form

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The accident happened on

I was a(n):


Please describe how the accident happened:

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:



My email address is:

My telephone number is

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.


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