If you or a loved one have been injured in an airplane accident you may be entitled to monetary compensation. Complete our free consultation form below and your claim will be submitted to an attorney. We will personally evaluate your case and may contact you to further discuss your situation, and/or attempt to refer you to a qualified lawyer who may be able to assist you.  Please be advised that by submitting a free consultation form, you are not entering into an attorney client relationship with our firm.

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Free Consultation

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Title:	Mr. Mrs. Ms. Miss Dr. Attny.
First Name:	*
Middle Name:
Last Name:	*
Home Phone:	*
Cell Phone:
Work Phone:
Email Address:
Address:	*
City:	*
State, Zip:	-- AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY *    *
What is the best way to reach you? Please provide the best place, time and method for contacting you.

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Injured Person Information:

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Date of Birth / Age: (ex. mm/dd/yyyy or 54)
Were you injured?	Yes    No
If not, who are you  inquiring on behalf of?	Self Family Friend Client Other

If you are NOT inquiring on your own behalf, what is your relationship to the injured person?

Is the person deceased?

Yes    No

If deceased, what is the cause of death as stated on the death certificate:

Date of Death: (ex. mm/dd/yyyy)
Was an autopsy performed?	Yes    No
If not deceased, does the  injury prevent you or the  victim from working?	Yes    No

If yes, when did you/victim stop working?

What is the approximate lost wages due to the injury?

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Accident / Injury Information:

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Date of Accident:	-- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   -- 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 *
City where accident occured:	*
State where accident occured:	-- AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY *

Please briefly explain the incident that caused the injury:

Who do you believe was at fault in causing the injury, and what do you believe they did wrong?

Describe the injuries in detail:

Do you believe the injuries are permanent?

Yes    No

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Case Description* Please explain exactly what happened, trying to state as thoroughly as possible who you believe was responsible and why you believe that person was negligent:

Please explain the full extent of the victims injuries:

Comments / Additional Information Is there anything else that would assist us in understanding the facts of your case?

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Please tell us exactly what terms you typed into the search engine to find us? (i.e. Personal Injury Lawyers)

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I understand that by filling out this free consultation form I am not forming an attorney client relationship. I understand that I may only retain an attorney by entering into a fee agreement and that by submitting this form I am not entering into a fee agreement. I understand that not all submissions may receive a response. Yes   No
I agree that the above does not constitute a request for legal advice. I agree that any 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. I agree that if this matter requires advice regarding my home state, local counsel may be contacted for referral of this matter. I understand that email is not secure and thus I am not forming a confidential relationship. Yes   No
I have read and agree with the TERMS AND CONDITIONS Yes   No By Clicking the box below, I agree to submit my case for a free case evaluation:
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