Tell Us About Your Personal Injury Case

There is absolutely no charge to have an initial consultation and to speak with one of our personal injury lawyers. You may submit the questionnaire anonymously (we just need an e-mail address or phone number so we can respond) or call us at 312.857.1710 to tell us about your case. We will respond, let you know what we think (if you have a case), tell you if we can help, and advise on next steps and a course of action.

When were you injured?
 /  / 
(mm / dd / yy)

Where?
City

State

What happened?


What are your injuries?

What medical treatment have you received?


Who is the insurance company for the person or business that caused your injury?


Is your injury work related?
Yes   No 

Contact Information

Email: 

First Name:* 

Last Name:* 

Address: 

City: 

State: 

Zip Code: 

Day Phone: 

Evening Phone: 

When is the best time to contact you?


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Photo: Chicago skyline. Personal injury attorneys Lipkin & Higgins with offices in Chicago serving clients in Illinois