Case Review Form

Case Review Form


For a free, no-obligation consultation with an experienced attorney at West Michigan Injury Lawyers, PC. regarding your case, please submit the following response form. We will respect the confidentiality of your information to the fullest extent. Form submissions are relayed to us through our highly secure servers.

Tell us who you are and how we can contact you. Note: This information is strictly confidential and will not be communicated with anyone. It is necessary only for purposes of enabling us to do a conflict of interest check prior to responding to you. We cannot respond without being able to do our conflict check. Email Field is required.

Your Name (required)

Your Email (required)

Street Address

City

State

Zip Code

Daytime Phone

Evening Phone

Please provide a brief personal background of the person needing assistance. Many times we are contacted by someone other than the person in need of help, such as a parent on behalf of a child, or wife on behalf of a husband. Please provide the following information on behalf of the person who needs assistance.

The following information is for myself:
YesNo

If no, my relationship to this person is:

First Name

Last Name

Age

Occupation

For how long:

Current or last employed

City and State last employed

Highest grade completed

School/College Attended

Degrees

Year degree granted

Special training

Why do you need help? Please provide us with a very brief overview, in 200 words or less, describing in general the subject matter of your request. You can provide more detailed information below, but for now please confine yourself to providing us with a brief statement of the general facts of your case, injury and damages.

State the date you were injured, or first learned of it:

What occurred?

Where did it happen?

City

State

County

Who caused the harm? Names and addresses of wrongdoers:

What damages were suffered?

Has anyone already filed a suit?
YesNo

When is the best time to reach you by phone?

When the information you have provided is complete, please press the Submit button below to send it to our firm. Your information will be kept strictly confidential.