Civil Rights Case Information

Please fill out this form as completely as possible. In order to evaluate your case, we must have complete responses to the questions. All information you provide is CONFIDENTIAL. After we have received your completed form, an attorney will determine whether or not this firm can represent you. THIS FIRM DOES NOT REPRESENT YOU AT THIS TIME. If you need immediate legal assistance, you should contact another attorney.

Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone
Email
Information About Your Civil Rights Claim
Name of the person(s) who violated your rights
Name of violator’s employer
Date of Incident
MM slash DD slash YYYY
Location of Incident
Briefly describe what happened to you and what relief you are seeking
How did you hear about our firm?
Do you have another attorney representing you at the present time?
- Yes
- No
If yes, who?

Civil Rights Case Information

Civil Rights Case Information

Information About Your Civil Rights Claim

Verdicts & Settlements

Wrongful Death: $5,500,000

Civil Rights: $1,230,000

DSS Settlement: $1,625,000

Medical Malpractice: $5,950,000

Personal Injury: $1,100,000

Personal Injury: $10,755,000

Personal Injury: $1,000,000

Personal Injury: $1,300,000