"Our Team Are Experts For Improving Your Quality Of Life." - Tony Seaton

I. Fault
When did you fall?
What caused you to fall?
Where were you?
What type of shoes were you wearing?
Any witnesses?	Yes No
Do you have a copy of the accident report?	Yes No
Do you have any photos or videos of the fall?	Yes No
What was the weather outside?
Were there any warning signs?	Yes No
What type of surface did you fall on?
II. Damages
What are your injuries?
What doctors have you seen?
What was the doctor diagnosis?
Have you had surgery?	Yes No
Estimate your total Medical Bills, including what you and your health insurance has paid?
Are you working?	Yes No
What is the total amount of your Lost Wages?
III. Insurance
Did other party have insurance or is it a business?
IV. Miscellaneous
Have you talked with another attorney?	Yes No
What are your main concerns at this point?


V. Contact
First Name:	*
Last Name:	*
Age:
Address 1:	*
Address 2:
City, State Zip:	***
Preferred Phone #:	*
Email Address:	*
I understand that by filling out and submitting our free consultation form I am not entering into an attorney client relationship with The Law Offices of Tony Seaton.

Slip and Fall Questionnaire