Seattle Personal Injury Lawyer - Timothy Wilson - Personal Injury Accident Attorney

FREE Case Evaluation Form
Fill out the form below to recieve your FREE case evaluation.

About the Injured Person

First Name:

Last Name:

Address:

City:

State:

Zip:

Email:

Home Phone:

Work Phone:

Age:

Sex:

Male Female

Date of Accident:

Location where
accident occurred:

(City, State)

Description of accident:

Was the injured party the:

Driver Passenger

Did the driver have insurance on the vehicle?

Yes No

Brief description
of the injury:

Broken bones?

Yes No

If yes, which bones?

Hospitalized?

Yes No

If yes, how many days?

Where?

Ongoing treatment?

Yes No

If yes, describe:

Was the injured party issued a ticket?

Yes No

Was other driver
issued a ticket?

Yes No Unsure

Anything else you
would like to tell us?

Law Offices of Timothy J. Wilson
T: (206) 381-3210 or (253) 874-5826
Seattle, Washington
info@personal-injury-lawyer-seattle.com