Slip & Fall Evaluation

Contact Information
Name:
E-mail:
Telephone:
Address:
City:
State:
Zip Code:
   
About Your Injuries
Date of Accident:
Please Describe Your Injuries:

Was Hospital Care Required? Please Explain:

Are You Able To Work?

Please describe any permanent injuries:

   
About the Accident
Where did the accident occur, please be specific?

Did you notice any signs warning of property hazards?

Yes No

Additional information:
How did you hear about us?


By clicking the above “Submit" button, you acknowledge that delivery of your information, comments and/or inquiry is not intended to create, and receipt does not constitute, an attorney-client relationship. David Resnick & Associates, P.C. cannot serve as your legal counsel in any matter unless we mutually agree that David Resnick & Associates, P.C. will represent you. No Attorney-Client relationship is formed unless specifically agreed to in writing. Additionally, you acknowledge that David Resnick & Associates, .C.has no obligation to maintain the confidentiality of any information you submit to us unless we already have agreed to represent you or we later agree to do so. Thus, we can represent a party in a matter adverse to you even if the information you submit to us could be used against you in that matter. Information sent over the internet is not necessarily secure from interception.

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We serve accident victims in Manhattan, Queens, Brooklyn, Staten Island, the Bronx and all of New York City. See our areas of practice page for more details.