Free Injury Case Evaluation

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 Law Offices of Clancey, Doyle & O'Donnell 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:

* Address:

* City:

* State:

* Zip Code:

* Home Telephone:

- -

Fax Number:

- -

* Email Address:

YOUR INJURY INFORMATION

* Date of Incident:
Is there a police report?
If yes, do you have a copy?
Type of Accident:
How did the Injury Happen:
Describe Your Injuries
Other Comments:

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

IF YOU OR A LOVED ONE HAS BEEN INJURED IN AN ACCIDENT
IT IS IMPORTANT TO PROTECT YOUR LEGAL RIGHTS.

PLEASE CALL US TOLL FREE:
1-800-632-5529

Email Us - info@cdolaw.com