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 (270) 846-3100 or toll free (800) 599-8888.

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

*Full Name

*Date of Birth

*Full Address

*E-Mail

*Phone

Please provide an 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.

Date of Injury.

Please describe your injuries.

Please describe any treatment you are presently receiving or have received for your injuries.

What is the approximate amount of your medical bills thus far?

If you have missed work due to your injuries, how much in lost wages and/or benefits have you sustained?

If you are currently represented by another attorney, please provide the attorney’s name, address and phone number.


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

Home Phone

Relationship to the person in need of assistance (e.g. parent, spouse, friend)


Disclaimer

- YES, I agree sending Crocker Law Offices an inquiry does not create an attorney-client relationship. We do not represent you unless we sign an agreement and confirm in writing that we have accepted your case. You should not rely on us to protect your interests unless we have a representation agreement. Every kind of case has important deadlines and if action is not taken before those deadlines your case could be barred. You should not send time sensitive material to us through the internet. We will not monitor the time limits applicable to your case and may not advise you about those limits in response to your internet inquiry, so it is important that you take appropriate steps to protect your rights.

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.

   
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