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Submit A Free Case Review

Please fill out the following for a free case review. The information submitted will be accorded the utmost confidentiality. This information is necessary in order to do a conflict of interest check before responding to you. If you prefer, you may contact us at 334-741-4110 or toll free 1-800-HURTLINE.

Please provide the following information for the person in need of assistance. Fields with (*) are required.


* Full Name

* Date of Birth

* Street Address

* City, State, Zip

Email

* Home Phone

Other Phone
Marital Status:

Name of Spouse, If Any

Occupation
Please provide a brief overview of the legal matter you need assistance with:

Injury Cases

City and State in which you were injured
Name(s) of the person(s) who you allege caused you injury, and their addresses, if known:
Please describe your injuries:
Please describe any treatment you have had so far:
Are you still being treated for your injuries?


If yes, what kind of treatment are you now getting and/or do you anticipate in the future?

What is the approximate amount of your medical bills thus far?
Have you been forced to miss work due to your injuries?



If so, how much in lost wages and/or benefits have you sustained?
Have you been contacted by any insurance company regarding your injuries?


If so, what is the name and address of the insurance company and adjuster(s) you have talked to?
Are you currently represented by another lawyer?


If so, please give us the attorney's name, address and phone number:
After the information is complete, please press the submit button. We will review the information and contact you as soon as we have done a conflict of interest check.

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Serving communities throughout Alabama, Georgia, and Washington DC our personal injury lawyers are dedicated to protecting the rights of victims. At the Mike Slocumb Law Firm, each client receives personal attention and vigorous representation.
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