Slip & Fall Evaluation

Contact Information
Name:
E-mail:
Telephone:
Address:
City:
State:
Zip Code:
   
About Your Injuries
Date of Accident:
Please Describe Your Injuries:

Was Hospital Care Required? Please Explain:

Are You Able To Work?

Please describe any permanent injuries:

   
About the Accident
Where did the accident occur, please be specific?

Did you notice any signs warning of property hazards?

Yes No

Additional information:
How did you hear about us?


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We serve accident victims in Manhattan, Queens, Brooklyn, Staten Island, Bronx and all of New York City. See our areas of practice page for more details.

If you need a personal injury attorney, or you’re uncertain of whether your situation requires a lawyer and have questions, contact David Resnick & Associates, P.C.

212.279.2000 or click here to find us online