Thank you for contacting Westchase Legal Center and taking the first step towards getting the help you deserve. We understand that reaching out after an injury can be difficult, and we appreciate you trusting us with your information.

In order to provide you the best service possible in evaluating your case, we ask that you fill out this form to the best of your ability. It is not a test, and there are no wrong answers. If you have any additional questions, please call or text us at (813) 926-0222 or email us at info@westchaselegalcenter.com.

We'll be in touch soon to discuss your situation and if we can best assist you. In the meantime, please don't hesitate to reach out if you have any questions.

Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!

Contact information: Prospective Client

Prefix

First name *

Middle name

Last name *

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

THANK YOU

Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We will contact you as soon as possible with any updates.

Please click the SUBMIT button below when you have finished answering all questions.

Contact information: Prospective Client

Preferred Contact Method

Gender

Are you currently employed?

What is the nature of your injury or claim?

What was the date of the incident that caused your injury or claim?

Please describe what happened that made you want to contact Westchase Legal Center.

Please describe any and all injuries or losses you have sustained as a result of the incident you described above.

Are you currently treating with a medical professional for injuries sustained as a result of this accident?

Have you retained a public adjuster to help estimate your claim?

Are you currently represented by another attorney for this matter?

Have you ever made a previous claim for an injury?

Please acknowledge that you have read and hereby accept the above privacy policy regarding use of my personal information by typing your full legal name below

THANK YOU