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Submit form or call toll free: (877) I WAS HURT for free telephone consultation.  Motor Vehicle Accidents, Auto Accidents,  Hit & Run Accidents, Uninsured Motorist Accidents, Serious Injury Accidents, Taxi Accidents, Truck Accidents, Bus Accidents, Train Accidents, Premises Accidents, Construction Site Accidents
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Welcome to 24-7Accident Lawyer's Personal Injury Questionnaire.

Michael W. Goldstein, Esq. has been practicing New York personal injury law since 1979.  If you sustained a serious injury, such as a fracture or an injury requiring surgery, please complete and submit the form below.

*Means required field.

Name
Address
City, State, Zip
Home Phone
Cell Phone (optional)
Work Phone
Email*
Fax
Date of Accident
Location of Accident


Did the police respond to your accident? Yes No
If so, do you have a police report? Yes No
Were you examined or treated at a hospital emergency room? Yes No
Were you hospitalized? Yes No
Did you see a doctor as a result of your injuries? Yes No
Are you currently under a doctor's care for injuries sustained in this accident? Yes No
How much time, if any, did you lose from work or school?

Description of Accident:
(Please include a description of what caused your accident, and who was at fault.)

 

 

Describe Your Injuries:

 

For motor vehicle accidents, describe the damage to the vehicles:

 

Please click the Submit button.  If you do not receive a Form Confirmation page, an error has occurred.  Therefore, kindly click here or call us at (212) 571-6848 or toll free at (877) I WAS HURT.

Your transmission of information or email to Michael W. Goldstein, Esq., or your completion and submission of our personal injury questionnaire, or a free telephone consultation, will not constitute an attorney-client relationship.

 

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Law Offices of Michael W. Goldstein, 299 Broadway, 8th Floor, NY, NY 10007
Phone: (212) 571-6848   Toll Free: (877) I WAS HURT  Fax:  (212) 619-6743

Representing accident victims seriously injured in car accidents, hit & run accidents, trip and fall accidents, construction site accidents, etc. in all 5 boroughs of New York City, as well as Nassau, Suffolk, Rockland and Westchester counties, and upstate New York, since 1979.

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