FREE Consultation

First Name: *
Last Name: *
E-mail: *
Phone: *

The Frison Firm, LLC.
Promenade II,
Suite 1900
1230 Peachtree Street
Atlanta, Georgia 30309
Office: 404.942.4330

Personal Injury Questionnaire

NOTE: The use of the Internet for communications with the firm will not establish an attorney-client relationship and messages containing confidential or time-sensitive information should not be sent via the Internet.


How were you referred to this office?

Name:

Street Address:

City:

State:

Zip:

Work Phone:

Home Phone:

E-mail:

Enter the Date of injury (mm/dd/yy)

What type of accident were you involved in?

Car Wreck Other

Do you have a copy of the accident report?

Yes No

Who was at fault on the accident report?

Who was the driver of your vehicle?

Were there any passengers?

Yes No

Was anyone else hurt?

How were you injured?

Did you go to the emergency room?

Yes No

If yes to the previous question, what ER did you go to?

Have you seen any other doctors?

Yes No

If the answer to the previous question is yes, please list the physicians:

What was the name of the at fault person's insurance company?

What is the name of your insurance company?

Do you have medical payments coverage?

Yes No

What are your time preferences for us to schedule an appointment for you?

Please list any additional information you fell is important:


THE FRISON FIRM represents clients throughout Georgia, including those in Downtown and Midtown Atlanta, Decatur, Alpharetta, Duluth, East Point, Lilburn, Stone Mountain, Lithonia, Covington, Clarkston, Peachtree City, Marietta, Conyers, Dallas, Savannah, Brunswick, Smyrna, Jonesboro, Lawrenceville, Sandy Springs, Buckhead, Gainsville, Athens, Austell, Carrollton, Macon, McDonough, Newnan, Norcross, Riverdale, Rockmart, Roswell, Stockbridge, Villa Rica and all cities within Fulton County, Dekalb County, Cobb County, Rockdale County, Gwinnett County, Bibb County, Whitfield County, Clarke County, Richmond County, Chatham County, Muscogee County, Floyd County, Houston County, Dougherty County, Clayton County, Carroll County, Henry County and Lowndes County.