Sokoloff & Weinstein Slip and Fall Accident Form

Below is a comprehensive form which will help you provide us with information required to evaluate your slip and fall accident claim (sometimes referred to as a trip and fall accident). By sending our slip and fall attorneys this information, you will essentially be helping us create your initial file.

Let Our Slip and Fall Accident Lawyers Represent You In Court

When our slip and fall accident attorneys contact you we will have a good deal of information on hand with which to help you. If you are unsure of any of the required information, please contact us directly by email at [email protected] or by phone at 561-790-6788 or 561-790-4505.

Personal Details

Your Name (required)

Your Last Name (required)

Your Address (required)

City (required)

Your State (required)

Zip (required)

Phone (required)

Your Email (required)

Accident Details

Date of Accident (required)

Time of Accident (required)

State in Which Accident Happened (required)

Was this Accident Work Related? (required)

Briefly Describe Your Accident (required)

Are You Currently Seeing a Doctor for this Accident? (required)

Health Insurance Details

Do You Have Health Insurance? (required)

Health Insurance Company (required)

Health Insurance Company Phone Number