We're here to protect your rights.
 

Salchow Law Firm

Personal Injury Case Evaluation

Offices serving the Kansas City, Springfield, and Joplin areas.

For all types of Personal Injury Cases 

The contents of this contact form are provided by and are the responsibility of the person posting the email communication. Your email will not create an attorney-client relationship.  You acknowledge that any reliance on material in email communications is at your own risk.  Items in red must be entered before the evaluation will be submitted.

1. Who was injured? (You may select more than one)
Myself
Family Member
Other (Please specify in the comments section.)

2. What are the injuries that were sustained? (You may select more than one)
Head injury
Broken extremity (arm/leg)
Internal injuries
Back/spinal cord injury

3. Has the injured party seen a doctor of any kind since sustaining his/her injuries?
Yes, he/she has seen a doctor.
No, he/she has not seen a doctor.

4. Where did the injury occur?
at work
at school
at the hospital
at home
in another location (Please specify in the comments section.)

5. In your opinion, the injury was caused by whom?
The person injured himself/herself.
Another person injured him/her, and we know who it was.
Another person injured him/her, and we don't know who it was.

6. Does either of the parties involved have insurance?
Both parties have insurance to my knowledge.
Neither party has insurance to my knowledge.
The injured party has insurance to my knowledge.
The party at fault has insurance to my knowledge.

7. Was a police report filed?
I believe a police report was made at the time of the injury.
I do not believe a police report was made at the time of the injury.

8. Comments: Please explain details from the event in the text box below that you feel are pertinent to the case that have not been covered in the questions above.

Your name:

Your street address:

City:

State: Arkansas Kansas Missouri Oklahoma

Zip Code:

Phone:

Email address:

   Reset