Silbowitz, Garafola, Silbowitz, Schatz & Frederick LLP

Submit A Free Case Review

Please fill out the following for a free case review. The information submitted will be accorded the utmost confidentiality. This information is necessary in order to do a conflict of interest check before responding to you. If you prefer, you may contact us at 1-800-EX-JUDGE (1-800-395-8343).

Please provide the following information for the person in need of assistance. Fields with (*) are required.

*Full Name

*Date of Birth

*Street Address

*City, State, Zip

E-Mail

*Home Phone

Other Phone

Please provide a brief overview of the legal matter you need assistance with.

Injury Cases

If you need assistance with an injury matter (including wrongful death claims, product liability claims and malpractice claims) please submit the following information as well.

City and State in which you were injured.

Name(s) of the person(s) who you allege caused you injury, and their addresses, if known.

Please describe your injuries.

Please describe any treatment you have had so far.

Are you still being treated for your injuries?

	Yes
	No

If yes, what kind of treatment are you now getting and/or do you anticipate in the future?

Have you been forced to miss work due to your injuries?

	Yes
	No

If so, how much time have you missed from work

If You Are Not The Injured Party

If you have filled this information out for someone else, and are not the person in need of assistance, please answer the following:

Full Name

Street Address

City, State, Zip

E-Mail

Home Phone

Please describe your relationship to the person in need of assistance (e.g. parent, spouse, friend)

For Parents or Guardians

If the person in need of assistance is not a minor or disabled, we will need to communicate directly with that person regarding our review, in order to maintain attorney/client confidentiality. If the person in need of assistance is a minor or is a disabled adult with an appointed guardian, we will need to communicate with that parent or guardian. With this in mind:

*Who is the person to be contacted after we have completed our review?

*What is the best time to contact that person?

*What is the best way to contact that person? (e.g., e-mail, phone, letter)

After the information is complete, please press the submit button. We will review the information and contact you as soon as we have done a conflict of interest check. An attorney client relationship is not established by submitting this initial contact information to our office.

PLEASE BE ADVISED THAT WE ARE NOT YOUR ATTORNEYS UNTIL YOU HAVE SPOKEN TO ONE OF OUR ATTORNEYS WHO HAS AGREED TO ACCEPT YOUR CASE AND YOU HAVE SIGNED A DOCUMENT AGREEING THAT WE REPRESENT YOU. UNTIL THAT DOCUMENT IS SIGNED THERE IS NO ATTORNEY-CLIENT RELATIONSHIP.

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Instructions For
Injury Clients

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