Click Here to Enlarge















Please include how you were injured, where and when you were injured, list of injuries, responsible parties, etc.  Please also indicate whether or not you have you spoken with anyone else about this matter?   (i.e. insurance company, police, other attorneys). 


  Contact Name    
  Day Phone    
  Evening Phone    
  Email Address    
  Street Address    
  Zip Code    
  Best Time To Call    
  Description of Negilgence.  Please be specific.      
  These materials have been prepared by Kaufman Law, P.C. for informational purposes only and are not legal advice. You should not act upon this information without seeking professional counsel. Transmission of information is not intended to create, and receipt does not constitute, an attorney-client relationship between you and the firm. The content of any correspondence you send via the internet will not be considered confidential unless you have received written confirmation to the contrary. Time-sensitive information should not be sent through this site.