Information Form When you or a loved one is injured the best course of action is to contact us by phone, even after business hours, as we regularly monitor our voice messages. But we understand that sometimes calling can be difficult so we provide this feedback form to make it easier for you to tell us about your situation. This form requires only a name and phone number. Name   Phone:         Optional Information: 2nd Phone:   Address 1   Address 2   City   State   ZIP   Email address   Sex   Female Male Marital Status   <Select One> Divorced Married Separated Single Occupation   Incident Date   Time of Incident   Description of Incident   Eyewitness Name   Eyewitness Phone Number   Doctor's Name   Doctor's Address   Doctor's Phone Number   Hospital's Name   Hospital's Address   Hospital's Phone Number

Disclaimer: The Colleran Firm only provides legal advice after it has entered into an attorney-client relationship, which this website specifically does not create. Only after having entered into a written, signed agreement with The Colleran Firm will an attorney-client relationship have been created. It is imperative that any action taken be done on the advice of counsel. Because every case is different, the descriptions of awards and cases previously handled are not meant to be a guarantee of success.