Personal Injury

Personal Injury Consultation Form

What type of personal injury case? (i.e. automobile, fall down, etc.)*
What type of injury did you sustain?*
When did it happen?*
How did it happen?*
Have you been to a medical expert regarding your injuries?*
- Yes
- No
Do you have personal injury insurance?*
- Yes
- No
Please complete below:*
First Last
Email Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employer or Insurance Company
Phone*
Short description of your case*
Do you prefer to be contacted via phone or email?*
Best time to contact you:*
Thank you for sharing your information with us. One of our attorneys will be happy to review your case and get back to you at your convenience.

Why Work With PC?

Highest firm rating (AV) from Martindale-Hubbell
Recognized by "Best Lawyers in America®" every year since 1995
Named in every "NJ Super Lawyers®" survey for Workers' Compensation since 2005 and 12 times for Personal Injury

Request a Free Consultation

Phone: (888) 675 - 7607

Fax: (609) 677 - 1790

Email: info@petrocohen.com

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Tuesday - 8:30 am–5:30 pm
Wednesday - 8:30 am–5:30 pm
Thursday - 8:30 am–5:30 pm
Friday - 8:30 am–5:30 pm
Saturday - Closed
Sunday - Closed
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