ACCIDENT / INJURY MATTERS INQUIRY
OUR LAW FIRM IS EVALUATING ALL CLAIMS FOR CATASTROPHIC OR PERSONAL INJURIES. Spiegel & Utrera, P.A, a Professional Association only handles catastrophic or serious personal injury cases for a contingent fee. That means there are no attorney’s fees unless we collect money on your behalf. There are also no upfront costs. If you think you, your loved ones, relatives and friends may have a potentional claim, call Larry Spiegel at (800) 603 3900, ext. 219 or submit your details below. Thank you.
STEP ONE. - COMPLETE AND SUBMIT THE  FORM BELOW.
STEP TWO. -  SPEAK DIRECTLY TO ONE OF OUR ATTORNEYS.
ENTER CONTACT  INFORMATION
Name:	*required
City:
State:
Phone Number:	*required
Email:	*required
	Please verify that you entered a correct address.
Corporation or Company Name: (if applicable)
All inquires must include a valid email & telephone number. Inquires without an email & phone number will be returned to you with a request for a valid email & phone number.
I need some questions answered by an attorney concerning my claim, dispute, mediation, arbitration or litigation.
Our office will respond immediately to details entered below by email or if requested, by phone. Please complete all the necessary contact information above or include it in the inquiry details.
Date of Incident or Accident:(mm/dd/yyyy)
Describe the Incident or Accident:
Name of Adverse Parties if Known:
Estimate Dollar Value of Past, Present and Future Medical Bills including hospital, doctor and other medical providers::
ENTER INCIDENT OR ACCIDENT DETAILS Please enter details regarding your incident or accident, such as parties, dates and locations. If this is an auto accident, enter year and make of vehicle.	Characters Left
Type the word in the image below to validate
Submitting this form does not create an attorney-client relationship.