The Gels Law Firm (3/06/12)
Accident Injury Form

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The use of the internet or this form for communication with the Gels Law Firm or any individual member of the Gels Law Firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

If you or a loved one has suffered an injury and you are seeking information to assist you in making a legal decision, we recommend you contact an attorney immediately.  If you would like to submit the facts of your case to an attorney from the Gels Law Firm, please fill out the form below and someone will contact you or contact an attorney at 205-552-9228.

 

Contact information:
First name:
 * required
Last name:
 * required
Email address:
Telephone number:
 * required
Mailing address:
 * required

  
City:

 * required

State:

 * required

Zip code:

 * required

Is this inquiry for you?

If no, please give name and relationship:

Facts about the injury:

Date of the injury: (mm,dd,yyyy)

Date of Birth of injured person: (mm,dd,yyyy)

What City and State did the injury occur? 

What kind of injury?:
Facts about the injury:
 

Facts about the collision:

Who was responsible for the collision?

Did the police respond to the collision?

Yes
No

Did anyone receive a ticket?

Yes
No

Did the other driver have insurance?

Yes
No

Did you have insurance?

Yes
No

Do you have an attorney?

Best way to contact you:

I understand that submitting this form does not create an attorney client relationship.  I agree that no information provided on this form is confidential or time sensitive.  

Yes
 

 

Important Note:  submitting this inquiry form does not mean The Gels Law Firm represents you.  In ordered to be represented by The Gels Law Firm you must be contacted by an attorney from this firm and sign an employment contract with us.