Personal Injury Questionnaire

Earn 10,000 American Airlines Frequent Flyer miles while we handle your case -- 2,000 when retainer signed, 8,000 at conclusion of your case!

For a free evaluation of your personal injury claim, please fill out the following form completely and submit it to us. We try to respond to all submissions by telephone, usually the following day. Please be aware that in submitting this form you are not retaining legal services from the Law Offices of Edward A. Smith.

The items listed in this form are the minimum facts needed for an attorney to begin to evaluate your claim, so even if you do not retain our services for your claim it will still be helpful for you to collect this basic information before contacting any other attorney.

And if you do decide to retain our services, we can get a jumpstart on formulating a plan of attack, putting together a powerful case so that by the time you meet with us, we are already well ahead of the game.

Contact Information:
Personal Information:
Case Information:
Investigated by:

Please do not include any confidential or sensitive information in this form. This form sends information by non-encrypted e-mail which is not secure.

Submitting this form does not create an attorney-client relationship.

Client Reviews
"Me and my wife; had a car accident. We were amazed how easy, professional, friendly attorney Ed Smith is along with his staff. Everybody is amazing. Thank you so much, we are very impressed!" Alex & Dinah M.
"Ed Smith and his office team took on a difficult personal injury case on my behalf and for the passenger in my car. Ed is a top- notch attorney. His staff couldn't have been more helpful and kind. No need to look elsewhere. I give Ed Smith my highest recommendation." Beverly
"Ed and Robert have been taking great care of my husband and I for the past 5+ years. They are always there when you have a problem and a quick resolution! Even when the issues have nothing to do with them. They are willing to help ease the pain off your shoulders. They are as good as it gets! Thank you again for everything." Annie T.
"Very professional. Great team, staff and service all around. Mr Smith was very honest, straight forward with his advice. He gives the word "attorney" an honest reputation. I will seek his council anytime, and would recommend him at the drop of a dime." Jeremy M.
"I would highly recommend Ed Smith to any friends or family in need of a personal injury attorney. Ed, and his staff, are very caring on top of being very experienced in this field. The staff always keeps you informed of the status of your case and they are always easy to reach by phone." Shannon D.
"Edward Smith law offices provide competent, thorough, and personable help for victims of personal injury. When you first meet the staff you know you contacted the right office. This law office treats clients like people. I recommend this office to anyone seeking representation regarding personal injury." David M.