Immediate Response Form

Please fill out the following e-form to the best of your ability, and an attorney from Trantolo & Trantolo we will be in touch with you shortly.

Tell us About You

*Name:
*Email:
Address:
City:
State:
Zipcode:

Phone (Day):

Phone (Eve):
When is the
best time to reach you?

 

Tell us Briefly What Happened

Date of Incident:
Were you injured?

Yes No

Describe your injuries:

Were you hospitalized? Yes No

Did you lose time from work?
Yes No
Do you currently have an attorney?
Yes No
Please provide any comments or details you'd like to share with us:
* Indicates a required field.  
Disclaimer  

Submitting this form to Trantolo and Trantolo via this online form does not constitute an attorney / client relationship. The information that you provide to us will serve as the basis of a subsequent, detailed interview with one of our attorneys at which point critical information regarding your case, and our ability to represent you, will be discussed.

I agree I do not agree

 


Trantolo & Trantolo, Attorneys at Law
50 Russ Street, Hartford, CT 06106
1-888-TRANTOLO

Copyright 2008 © Trantolo & Trantolo

All rights reserved.

Webdeveloper: Jacqueline A. Roemmele

The information provided on this website is for informational purposes only and does not constitute legal advice. Contacting Trantolo & Trantolo via email or online email form does NOT constitute an attorney-client relationship.