Claim Evaluation

We can begin the evaluation of your injury claim on-line. Below, you will find a questionnaire that will help us better evaluate your claim. After reviewing your on-line submission, we will call you within 24 hours to obtain additional information. Please fill out the questionnaire completely. All submissions are kept strictly confidential.

A submission of the questionnaire and any reply to it does not imply or create an attorney-client relationship. If you already have an attorney, you should rely on your attorney’s advice. If we should accept your case, then you may rely on our formal recommendations.

Please fill out the questionnaire below to submit your claim for evaluation:

Full name:
Street Address:
City:
State:
Zip:
Email Address:
Area code:(
) Telephone Number:
Describe how you were injured:
Injuries suffered by you or others:
Amount of wage loss, if known:
Treatment received to date:
Amount of medical bils, if known:
Who do you feel is responsible for your losses and why?:
Are they insured?
No
Yes
If so, by what company:
  
Free Consultation
By Phone:
Call us today for your free initial consultation.
(425) 744-1184
Claim Evaluation:
Submit an
ONLINE FORM for your free initial
claim evaluation.
Donchez Law Firm • 8318 - 196th Street S.W., 1st Floor • Edmonds, Washington 98036-6434 • (425) 744-1184 • info@donchezlaw.com