Personal Injury

We need some basic details about you and your personal injury claim in order to determine whether or not you have a case that we can accept. Any information which you provide in this on-line questionnaire will be kept confidential and will be sent directly by e-mail to our firm. After we receive your inquiry, we will contact you to discuss how we can help you. However, to save you time and best serve your needs, please note that we CANNOT assist people from outside ONTARIO, CANADA.

Name First Last
Phone - (###) - ### ####
Cell Phone - (###) - ### ####
Email
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Date of Incident
Location of Incident

Provide geographic location of incident.
Description of Incident

Describe the incident that lead to injury.
Describe injuries sustained
Type the letters you see in the image below.