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Spinal Cord Injuries Contact Form

When you are faced with a spinal cord injury, an attorney who has regularly advised and represented clients in these matters can help you achieve a cost-effective and timely resolution. To learn more about our legal services, contact our firm to schedule a consultation with an experienced attorney.

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Spinal Cord Injuries Contact Form

Name

E-mail Address

Phone Number

Business Phone

Cellular or Pager

Address

City

State

Zip

Injury Information

Have you been diagnosed with a spinal cord injury?
Yes No

If so, please identify the type of injury (C4, T12, etc.)

What was the date and time of your injury?

Name, address, and phone number of your physician(s):

Was the injury complete or incomplete?

When and where were the following tests completed?

CT Scan
MRI
X-rays

Where did the accident occur?

Please describe the details of the accident.

Please provide the names of witnesses to the accident.

If an automobile was involved, please list the make, model and year.

If the accident occurred on a construction site, please provide the address and name of the site supervisor.

Please provide any other relevant information or concerns:

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Seidman Law Offices | Personal Injury Attorney | Chicago, IL

The Chicago personal injury and workers compensation attorneys at Seidman Law Offices handle car and truck accident claims, medical malpractice, and workers? compensation. Call us at 312-781-1977 or visit http://www.seidmanlaw.net.