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Please complete ALL fields in the form below so that we may review your claim.
First Name
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Last Name
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Email Address
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Phone Number
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State
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Pennsylvania
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Nature of Your Claim
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ATV/Boating Crash
Bicycle/Pedestrian Injury
Birth Injury
Building Collapse
Cancer Delayed Diagnosis
Car/Trucking/Motorcycle/Bus Accident
Civil Rights Violation
Construction Site Injury
Criminal Assault at a Business, Bar, Nightclub, or Other Commercial Establishment
Dangerous Drug, Medicine, or other Medical Device Failure
Defective or Dangerous Product or Vehicle
Dog Bite Attack
Drunk Driving Crash/Dram Shop (Bar Overserved Alcohol)
Electrocution/Burn Injury
Exposure to Asbestos, Harmful Chemicals, or other Pathogens
Hazing Injury
Medical Malpractice
Nursing Home Neglect
Plane Crash
Pool/Drowning Accident
Recreational Injury
Ride Share Crash
Sexual Abuse, Assault, Rape, or Other Indecent Contact
Slip/Trip & Fall Accident
Train Accident/Derailment
Vehicle Rollover
Workplace Injury
Wrongful Death
Other
Date of Incident
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Please provide a summary of the nature of your claim
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I acknowledge that by submitting this form, an attorney/client relationship is NOT being created between myself and the law firm.
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By providing my phone number to Hoffman, Sternberg, Karpf & Lynch, LLC, I agree and acknowledge that Hoffman, Sternberg, Karpf & Lynch, LLC may send text messages to my wireless phone number for any purpose. Message and data rates may apply. Message frequency will vary, and you will be able to Opt-out by replying “STOP”.
No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.
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