The Law Office of Trevor A. Taylor

Austin Office:

Map

The Commissioner’s House at Heritage Square
2901 Bee Cave Road, Box J
Austin, Texas 78746
(512) 322-0202

Houston Office:

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The Niels Esperson Building
808 Travis St., Suite 1101
Houston, Texas 77002
(713) 229-8313

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DO YOU HAVE A CASE?

If you have been in an automobile accident, answer the following questions:
* = Required

*Name:
*Telephone Number and area code:
*E-Mail Address:
Have you spoken to another attorney about your case?	Yes No
If so, has the attorney agreed to represent you?	Yes No
Where did the accident occur? (city, town or county)
Who was at fault?
Did the police write a report?	Yes No
Did the police issue any tickets?	Yes No
If "Yes", to whom did they issue the ticket?
What kind of injuries did you suffer?	Select One Please: Serious (broken bones, nerve damage) Moderate (concussion, bruises) Mild (strain, pain)
Were you taken to the emergency room after the accident?	Yes No
Have you seen a doctor for your injuries?	Yes No
Are you receiving any treatment for your injuries (physical therapy, chiropractic)?	Yes No
Does the other driver carry insurance?	Yes No
Do you carry insurance?	Yes No
Was the other vehicle a commercial vehicle or truck?	Yes No
What is the estimated amount of property damage to your vehicle?	Select One Please: Over $5,000 $2,500-$5,000 Under $2,500
Additional comments:

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Note: Submitting this form does not create an attorney client relationship.

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