FREE CONSULTATION

Please fill out the following Case Evaluation form and provide as much information as possible. All information is kept strictly confidential and is used only by the Shergill Law Firm for the evaluation of your case. By accepting and reviewing this completed form, we are not agreeing to represent you. Rather, we will evaluate your information to determine whether or not we can accept your case.

Note: fields with a * are required.

YOUR CONTACT INFORMATION
First and Last Name:

Telephone:

Email Address:

YOUR INJURY INFORMATION
Date of Injury:

How were you injured:

Describe Your Injuries

Other Comments:

**PLEASE DO NOT GIVE A WRITTEN OR RECORDED STATEMENT TO THE INSURANCE COMPANY!**

Comments are closed.