Richard S. Paddor | Attorney At Law

CASE EVALUATION FORM

Your completion of the evaluation form concerning a potential case you might have is very important to me. I am very sensitive to your needs I commit to you that I will promptly respond even if I cannot help you.

My review of the completed case evaluation form does not constitute an attorney-client relationship. Mr. Paddor's review of the case evaluation form does not mean I am representing you. For Mr. Paddor to be hired as your lawyer, a written retainer agreement must be signed by you and him.

Please submit this form for a FREE evaluation and consultation.

Please provide as much information as possible. You will receive a response shortly. All information received will be kept strictly confidential.

What kind of legal matter do you have?
	Accident
	Workers' Compensation
	Other

Name
Street Address
City
State
Zip Code
Home Phone
Work Phone
Fax
E-mail

Please provide the following information:
Date of Birth:
Date of Accident:

If Workers Compensation, Name of Employer:
Job Title:
Place of accident:
Description of accident:
Description of injuries:
For auto accidents, any passengers?
Names and phone numbers of all passengers:
Name, address and telephone number of responsible party?
Why do you believe that party is at fault?
Identify the responsible party's insurance company?
Did you have auto insurance on the date of the accident?

CASE EVALUATION FORM

Please submit this form for a FREE evaluation and consultation.

What kind of legal matter do you have?

Please provide the following information: