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Accident News
(800) 892-5044

Contact Us - Vehicle Accidents Evaluation

Barry & Loewy LLP encourages prospective clients and referring counsel to contact us for a FREE initial consultation about the specifics of your case.

You may contact us by phone at (800) 892-5044, or by email at info@barryloewy.com. You may also contact us by filling out the electronic Questionnaire below.
 
First Name: *
Last Name: *
Street Address:
City, State, Zip:
Home Phone: *
Work Phone:
Email: *
What is the best way to reach you?
Are you seeking information for yourself or someone else? Yes No
Is an attorney currently representing you in this matter? Yes No
How did you hear about us?
 
Accident Information
Date of accident:
Time of accident:
Location of accident (include city, state and specific street names, if possible)
What caused the accident?
Did injuries result to you, your passengers, or the other driver and passengers as a result of the accident? Yes No
If you have injuries, do they prevent you from working? Yes No
     If yes:  
     When did you stop
     working?
     How much income have
     you lost as a result of the
     accident and your injuries?
     What are your medical
     expenses to date?
Is there damage to your vehicle or the other driver’s vehicle? Yes No
     If yes:  
     What is the approximate
     damage to your vehicle?
     Are you renting a vehicle
     and, if so, what is the
     cost?
     What is the approximate
     damage to the other
     driver’s vehicle?
Do you have a copy of the police report? Yes No
Was the driver of the other vehicle charged with a DUI? Yes No
Name of your auto insurance company:
Name of the other driver’s auto insurance company:
Any other information you feel is valuable to your case:
  Please do not include any confidential or sensitive information in this form. This form sends information by non-encrypted e-mail which is not secure. Submitting this form does not create an attorney-client relationship.