(Monro Stephen K Law Office of Inc PS - Everett, WA ) Request Info

: Please complete this form and submit it, if you wish to be contacted by a representative of Stephen K. Monro, Inc., P.S. You only need to respond to the questions to which you know the answer.

		First Name *		Last Name *

		Street Address *

		City *		State *		Zip Code *

		E-mail Address

		Home Phone		Work Phone		Mobile Phone

		Date of Birth MM/DD/YY		Date of Injury MM/DD/YY

		Type of Injury

		City and State where injury occurred:

Work Status Due to the Injury:

Able

Unable

Medical Treatment Required?

Yes

Currently in Treatment?

Yes

		Describe Injuries:

		Cause of Injury:

		Comments

		How do you wish to be contacted?

		When should we call you?

How did you hear about us?

Yellow Pages	Internet
Client Referral	Other

We will try to respond to you as soon as possible regarding your inquiry. Thank you for the information you are able to provide because it will help us evaluate your claim. Please be aware that a telephone inquiry, an e-mail, or other communication to The Law Offices of Stephen K. Monro does not create an attorney-client relationship. This firm cannot serve as your counsel in any matter unless both you and a representative of our firm sign an agreement confirming in writing our attorney-client relationship. You should also be aware that the statutes of limitation (the deadlines imposed by law within which you must bring a lawsuit) may severely limit the time remaining for you to file any claims you may have and, ultimately, could bar those claims. Accordingly, you should take appropriate steps to protect your legal rights. By submitting this evaluation form, you are agreeing to the above.

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