Motor Vehicle Collision Intake Form

Bold labels and indicate required information.

Personal Information Name

Please enter your name.

Address

City

Province

Phone

Please enter phone number.

E-mail Address

Please enter a valid e-mail address.

How Can We Help You? Date of injury:

Description of injuries:

Where and when did the collision occur?

Please describe the circumstances of the collision.

Have the police laid any charges against you or the other driver(s) involved?

Were you taken to the hospital?

What medical treatment have you received for your injuries?

Was anyone else injured in the collision?

Were you employed at the time of the collision?

If you were employed, please describe your occupation and your approximate income:

Have you returned to work?

If you have returned to work, are you working at the same level that you did before the collision?

Please provide any other comments or information that would help us to evaluate your case:

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

Please verify that you have read the disclaimer. I have read the disclaimer.

Personal Injury

Bold labels are required.

Contact Information Name

E-mail Address

Please enter a valid e-mail address.

Phone

Brief description of your legal issue

Please verify that you have read the disclaimer. I have read the disclaimer. disclaimer.

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an lawyer-client relationship. Confidential or time-sensitive information should not be sent through this form.

The lawyers of McLeish Orlando LLP are committed to achieving positive results for people who have been injured...

We’ve helped several people at our firm. These are some of the stories and examples of our success...

Our Lawyers have answered some of the more common questions asked by our clients.

McLeish Orlando LLP represents clients in the greater Toronto area (GTA) and throughout southern Ontario, including residents of Hamilton, Oakville, Burlington, Mississauga, Brampton, Woodbridge, Richmond Hill, Markham, Vaughan, Oshawa, Ajax, Whitby, Pickering, Newmarket, Aurora, Barrie, Ottawa, London, Kitchener, Waterloo, St Catharines, Niagara, Kingston and Guelph, Ontario.

FirmSite® by FindLaw, a Thomson Reuters business.
Disclaimer | Site Map