Civil Case Evaluation Form

Name: *

Address:

City:

State:

Zip Code:

Email:

Phone: *

General Evaluation:

Are you the plaintiff or defendant in this case?

Has the other party secured a lawyer?

Have you been served with a summons or complaint?

Are you willing to settle this case without going to trial?

Are you willing to have your case decided by arbitration or mediation?

Please provide a brief description of your legal situation:

What are your goals for your lawyer?

Injury Evaluation:

Type of Injury

Date of Injury

Location of Accident:

Additional Information associated with the accident/injury

Accident Evaluation:

Type of Accident:

Date of Accident:

Time of Accident:

Were there any tickets issued?

Name of your insurance company:

Name of the other insurance company:

Type of injury associated with the accident:

Describe the accident in as much detail as possible:

Vintage