The Law Firm of Specializing in Personal Injury Cases Email: AskUs@jamesoelliott.com	Phone: 248-334-1500 Toll Free: 800-755-2636 Fax: 248-334-5940 Address: 43494 S. Woodward Suite 205 Bloomfield Hills, MI 48302
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If you would like Mr. Elliott to review the provided information please fill out and submit this form and follow up with a telephone call.

First & Last name:
Street Address:
City, State, Zip Code:
Phone Number:
E-Mail Address:
Age:
Were you injured:
When did it happen:
Location of accident or malpractice (city, state):
If auto accident, was there a police report:
What injuries do you have:
Do you presently have an attorney on this case:
Please describe what happened (100 word maximum):

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