CASE EVALUATION

There is ABSOLUTELY NO CHARGE for the initial consultation. You may submit the contact form providing your name and e-mail address, so we can respond to your inquiry. Usually, we are able to respond to most inquiries in 24 hours or less. All inquiries--by e-mail or phone-- are totally confidential. You should use the questions below as a checklist in preparing your e-mail to us.

1. WHEN DID YOUR ACCIDENT HAPPEN?
   
2. WHERE DID IT HAPPEN?
   
   1. ON THE WATER?
      
      
      1. ON A JACK-UP DRILLING RIG
      2. ON A SEMI-SUBMERSIBLE
      3. ON A DRILL SHIP
      4. ON A CREW BOAT, WORK BOAT ,ETC.
      5. ON A CONSTRUCTION BARGE
      6. ON A LIFT BOAT
      7. ON A DREDGE BOAT
      8. ON A PERMANENT PLATFORM
      9. OTHER
         
   2. ON LAND?
      
      
      1. ON A LAND BASED DRILLING RIG
      2. WORKING ON THE RAILROAD
      3. AT A RAILROAD CROSSING
      4. IN A MOTOR VEHICLE ACCIDENT
      5. OTHER
         
3. WHAT INJURIES DID YOU SUFFER?
   1. HEAD
   2. BRAIN
   3. NECK
   4. SHOULDER
   5. ARM
   6. HAND
   7. MID-BACK
   8. LOW BACK
   9. SPINAL CORD
   10. LEG
   11. HIP
   12. KNEE
   13. ANKLE
   14. FOOT
   15. BURNS
   16. OTHER
       
4. WHAT MEDICAL TREATMENT HAVE YOU RECEIVED?
   1. HOSPITAL
   2. DOCTOR
   3. OTHER
      
5. IS YOUR ACCIDENT WORK RELATED?
   1. YES
   2. NO
      
6. WHAT HAPPENED?
   
7. CONTACT INFORMATION (**E-MAIL ADDRESS or TELEPHONE NUMBER)
   1. NAME
   2. STREET ADDRESS
   3. CITY
   4. STATE
   5. ZIP CODE
   6. E-MAIL ADDRESS **
   7. TELEPHONE NO.**
      
8. BEST TIME TO CONTACT YOU?
   1. MORNING
   2. AFTERNOON