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Full Name:
Phone Number:
Work Phone Number:
Email Address:
Street Address:
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Please describe your injuries:
Were your injuries a result of:
Did a wrongful death occur? Yes No
Was hospitalization required? How long?
Please describe your medical treatment:
Please list any permanent injuries:
Did your injures cause you to be out of work? How Long?
Please approximate your medical expense:
Have you spoken with another attorney? Yes No
Have you retained an attorney for this injury? Yes No
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Please know that you are not considered a client of our firm until your case has been accepted by us, and you have signed a formal "retainer agreement."


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Recall News
DIGITEK RECALL!

The FDA has recalled all Digitek tablets after the discovery of manufacturing defects.  Individuals taking Digitek tablets may suffer from an illness known as Digitalis Toxicity and various other symptoms.  This manufacturing defect may cause serious health problems, and even death.   

Product Recall
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The Peterson Foundation, Inc. was established by David M. Peterson to support children in need throughout the Kansas City area. For more information click here.

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