Date of Inquiry *

Name *

Address *

Phone (Home) *     Phone (cell) *

Email address *

Nature of Inquiry *

    Auto Accident                          Insurance Dispute

    Boat Injuries                             Motorcycle Claims

    Business Dispute                    Premises Liability

    Civil Rights                               Product Liability

    Consumer Rights                     Professional Malpractice

    Discrimination                          Social Security Benefits

    Employment                             Workers Compensation    

    Fire Insurance Claims             Other

Please describe the facts surrounding your claim or dispute including all

relevant dates:

Remember that all claims are governed by a statute of limitations which requires that claims be brought within a specific, often short, time period or your right to recover may be lost. Your claim may also be subject to legal notice requirements which must be met to protect your rights. If you believe you have a valid legal claim, it is very important that you seek legal advice as soon as possible.

DATE OF THE INCIDENT *  

Last date employed or date of wrongful action

HOW DID YOU FIND US? Who referred you to us or where did you find reference to our firm:

Insurance company involved, if any?

Care provider(s):

Doctor(s):

INJURY(IES) OR DAMAGES SUFFERED?

PERSON(S) OR ENTITIES BELIEVED TO BE AT FAULT:

ANY WITNESSES KNOWN TO YOU:

*Mandatory information to assure that we can respond to you if we identify a time issue.

PLEASE NOTE THAT YOU CANNOT CREATE AN ATTORNEY-CLIENT RELATIONSHIP WITH US BY E-MAIL. WE CANNOT ASSUME ANY OBLIGATION TO ADVISE YOU OF YOUR RIGHTS OR TO PROTECT THEM, ELECTRONICALLY. IN ORDER FOR YOU TO ENGAGE US TO CONSULT WITH YOU ON A PROFESSIONAL BASIS, WE MUST MEET AND ESTABLISH AN ATTORNEY-CLIENT RELATIONSHIP. WE WILL ATTEMPT TO PROVIDE GENERAL INFORMATION ELECTRONICALLY WHERE WE HAVE AN ADEQUATE UNDERSTANDING OF THE FACTS UNDERLYING THE QUESTION BEING ASKED. IF YOU BELIEVE YOU MAY HAVE A VALID LEGAL CLAIM, YOU SHOULD SCHEDULE A FORMAL MEETING WITH AN ATTORNEY TO DISCUSS YOUR RIGHTS IN DETAIL.

Of course, we'll be happy to discuss your case at no charge. Telephone our office to make an appointment for a free consultation or to receive our brochure. 1-231-929-9700. Or email us at info@tovlaw.com.