Atlanta Georgia attorney law firm practicing in mental or physical injury, negligence and damages.



	Personal Injury Questionnaire For a free evaluation of your personal injury claim, please fill out the following form completely and submit it to us. We try to respond to all submissions by the following day. Please be aware that in submitting this form you are not retaining legal services from Moffett Law Firm, P.C. Name: E-Mail Address: Business Telephone Number: Home Telephone Number: Your Insurance Carrier: Negligent Party's Insurance Carrier: Date of Incident: Place of Incident: Investigated by: State Patrol Sheriff Local Police Other Agency None FACTS: In your own words, describe how the incident occurred. What injuries resulted from the incident, who was injured, and how have the injuries progressed?: What medical treatment has taken place? Medical Expenses to Date: Time Loss from Work to Date: Property Damage: Transportation Costs, Car Rental, etc: Any Other Losses:

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Disclaimer: We are not giving advice. We are not your lawyers. The information supplied on this web site is general in nature and should not be relied upon to make legal decisions. Interacting with e-mail on this page or our Personal Injury Questionnaire does not constitute the creation of an attorney/client relationship. This web site is an advertisement for legal services. Any examples of client cases and results discussed on this web site are not a guarantee of your outcome if we represent you in a particular case. The material contained in this website is not intended as legal advice, and you should not rely upon it being applicable to any specific case you may have. All information contained in this website pertains to the law in the State of Georgia. The laws of other states and nations may be entirely different from what is described here, and you should contact an attorney licensed to practice in your area if you need advice regarding the law.