2. Provide a brief personal background of the person needing assistance.

Many times we are contacted by someone other than the person in need of help, such as a parent on behalf of a child, or wife on behalf of a husband. Please provide the following information on behalf of the person who needs assistance.

The following information is for myself: Yes No


3. Why do you need help?

Please provide us with a very brief overview, in 25 words or
less, describing in general, the subject matter of your request. You can provide more detailed information below, but for now please confine yourself to providing us with a brief statement of the general facts of your case, injury and damages.



4. State the date you were injured or when you first learned that you had been damaged:

YYYY.MM.DD (e.g. 2002.01.01)


5. What damages were suffered?

6. Has anyone already filed a suit?

Yes No


7. How can we help you?

What is your goal? Explain here what you hope to acheive by working with a qualified lawyer on this issue.




If the information you have provided is complete, please press the Submit button below to send it to Dordick Law. If you wish to start over, press the Clear all fields button below and re-enter all information. Your information will be kept confidential.