Personal Injury, General Contact Form

If you have lost a family member or suffered injuries as a result of another person's negligence or misconduct, a personal injury attorney who knows how to protect your rights can work with you to negotiate the best possible result according to the facts and applicable law. Don't delay. Contact our firm today to schedule a consultation and case evaluation.

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Personal Injury, General Contact Form

*First Name

*Last Name

*Email Address

*Phone Number

*Zip

Street Address

Apt/Ste

Incident Street Address

Incident Apt/Ste

*Incident Zip

When were you injured?

How did the accident/injury happen?

Where did the event occur?

Was the accident/injury work-related?
Yes No

Were there any witnesses to the occurrence?
Yes No

Was an investigation conducted (police or otherwise)?
Yes No

Did you do anything to cause the accident?

Did you know any of the parties involved, prior to the accident?

When did you first receive medical care for your injury?

What was your diagnosis?

What treatment have you received?

How has your lifestyle changed as a result of the accident?

DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.

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EHRLICH, PETRIELLO, GUDIN & PLAZA
A PROFESSIONAL CORPORATION

MAIN OFFICE-NEWARK, NEW JERSEY

60 Park Place
Suite 1016
Newark, New Jersey 07102-5504
Phone: 973-643-0040
Toll Free: 866-974-9960
Fax: 973-596-1781
Map & Directions

NEW YORK CITY OFFICE

555 5th Avenue, 14th Floor
New York, New York 10017-3507
Phone: 212-643-2503
Map & Directions

MORRISTOWN, NEW JERSEY OFFICE

89 Headquarters Plaza North, #1459
Morristown, New Jersey 07960-6834
Phone: 973-718-2229
Map & Directions

Ehrlich, Petriello, Gudin & Plaza, A Professional Corporation, represents clients in business and commercial law, commercial litigation, real estate, criminal defense, and family law throughout Northern and Central New Jersey, including Newark, Hackensack, Elizabeth, Morristown, Paterson, Jersey City, New Brunswick, Somerville, Morris County, Union County, Hudson County, Middlesex County, Monmouth County, Westchester County, Hunterdon County, Somerset County and Bergen County; and also serves clients throughout New York City from its Manhattan office.