Brooks, Sanborn & Mulcahy, LLP | Business & Commercial Law Lawyer Springfield

Attorneys at Law
Welcome
Firm Overview
Practice Areas
Attorney Profiles
Information Form
Resource Links
Directions
Contact Information

Information Form

If you are interested in meeting with one of our staff regarding your legal needs, please fill out the information below and bring with you for your initial consultation.

Name:
Address:
Have you already consulted an attorney about this matter?
Yes   No
What benefit would you like to receive from our advice?
Date of Birth:
Marital Status:
Number and ages of children:
When did you graduate from high school?
When did you graduate from college?
What do you do for gainful employment?
Do you work in your home? Yes   No
How long have you worked at your present job?
What do you do at your place of employment?

If you are contacting us with reference to a motor vehicle accident, please answer the following questions. If not, please skip down to answer any of the questions below which pertain to your question for us.

Date of Accident (if motor vehicle accident case):
Date of Incident:
Describe incident or issue briefly:
If this is a personal injury matter, state the
types and approximate dates of your treatment:
Are you done treating for your injuries? Yes   No
Are you all better? Yes   No
If not, what unresolved injuries do you have?
Has any physician told you that you will not get better?
Yes   No
What are your total medical bills to date?
Do you have health insurance? Yes   No
Do you have other insurance available to cover your losses?
Yes   No
Have you reported this matter to your insurance company
or companies? Yes   No
Who injured you?
When?
If this is not about personal injuries, but involves suing
someone or being sued, describe the situation briefly:
If this matter is about business, for example, real estate
investment, banking, a contract or lease, a financial
workout or protecting your assets, describe the situation
briefly and state how you would like to see the situation
resolved:
If this is about a will, trust or estate planning, state the
value of all property which you own in your own name
alone:
Do you have a will? Yes   No
Do you have a power of attorney? Yes   No
Do you have a homestead protection to protect the value
of your home from creditors? Yes   No
Do you have a living will or health care proxy?
Yes   No
Have you been injured by a wrongful act of another person?
Yes   No
If so, how:


 


 

Welcome | Firm Overview | Practice Areas
Attorney Profiles | Information Form |  Resource Links |  Directions |  Contact Information

The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for individual advice regarding your own situation.

Copyright © by Brooks, Sanborn & Mulcahy, LLP. All rights reserved. You may reproduce materials available at this site for your own personal use and for non-commercial distribution. All copies must include this copyright statement.