In order to better understand your case we would like to gather some more information. Please complete the form below and Larson Law will review the information and contact you within 72 hours. Please note, This is this is a CONFIDENTIAL and ENCRYPTED questionnaire for the use of this office only in preparing your claim for personal injuries. Please answer every question fully, honestly, and accurately because, as your attorneys, the more we know about you and your case, the better we will be able to represent you. There are 13 sections, and each of the questions are important even though they may not appear to have anything to do with your case.
Please provide the following information for each and every medical provider who has treated you since the accident. This information is very important. Failure to provide information may cause medical expenses to be incorrect for which you may be liable.
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