Personal Injury and Malpractice : MEP of Indiana

Injured? We can help!

To contact us and schedule your initial consultation, please fill out the form provided below and one of our staff members will contact you as soon as possible.

The submission of any information to www.meplegal.com does not constitute an attorney-client relationship.

Your Name:

City:

State:

Zip:

Email Address:

Home Phone:

Cellular Phone:

Who was injured? -- Injured Person's Name (if different from above)

Injured Person's Information (if applicable and different from above):

City:

State:

Zip:

Email Address:

Home Phone:

Cellular Phone:

When did the Injury Occur:

Where did the injury occur?

Did the injury occur on another's property?

If yes, who owns the property and what City/State is it located in?

How did the injury happen?

Tell us of any surrounding circumstances (weather, lighting, conditions, other)

Were there witnesses to the injury?

If yes, what are their names? Also provide contact information if available.

Were others involved or injured at the same time?

If yes, what are their names? Also provide contact information if available.

Was there a police report?

Did the injured person receive medical treatment?

Is the injured person still receiving medical treatment?

Was the injured person killed as a result of the accident?

Did the injured person have other losses resulting from the injury (lost wages, damaged property, other)? If so, explain:

I understand that the contents of this contact form are provided by and are the responsibility of the person posting the email communication. I understand that any online submissions through http://meplegal.com will not create an attorney-client relationship and will not necessarily be treated as privileged. By clicking on 'Submit', you acknowledge that any reliance on material in email communications is at your own risk, and that you have read MEP's legal information disclosure.