Client Questionnaire -Trial Lawyers - Personal Injury

mouzourakis & company, trial lawyers, vancouver, bc

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Client Questionnaire

We need to know about you, the damages you suffered, and the persons that caused the damage in order to determine whether or not you have a case that we can accept.

Any information which you provide in this on-line questionnaire will be kept confidential and will be sent directly by e-mail to Mouzourakis & Company Trial Lawyers. After we receive your inquiry, we will contact you to discuss how we can help you.

We do not handle Worker's Compensation (WCB) cases.

We also do not handle Medical Malpractice, and Property Damage claims.

If you are unsure if your case falls into these areas please fill out the Free Online Assessment below.

Please fill out the form below completely.
* indicates required field

*Name:

*Address:

*City:

*Province:

*Postal Code:

*E-mail:

*Home Phone:

Business Phone:

Cell Phone:

Fax:

Are you known by any other names?
Yes  No
If yes, list other names you have used:

What is your marital status?

Does this matter involve a business you own or run?
Yes  No
If yes, provide the business name, address, and phone:

If a business is involved, how is the business organized (if known)?

Are you employed?
Yes  No
If yes, please provide your job title and employer's name and address.

Can you be contacted at work?
Yes  No
What area of law does your situation involve (if known)?

Describe your situation, including any relevant dates:

How would you rate your legal needs described here?

Are any other people involved?
Yes  No
If yes, provide names, addresses (if known), and their relationship to you, if any:

Do you have any documents that could help explain your situation?
Yes  No
If yes, list those documents and their dates:

Are there other documents that you do not have access to that could be of assistance?
Yes  No
If yes, list those documents and their dates and locations (if known):

Describe how this situation has impacted you:

Describe what you would like to happen to resolve your issue (your preferred outcome):

Have other lawyers worked on this matter?
Yes  No
If yes, provide names, addresses, and a brief description of their involvement:

Special concerns:

Where did you hear about our website?

The contents of this contact form are provided by and are the responsibility of the person posting the email communication. Your email will not create a lawyer-client relationship and will not necessarily be treated as privileged or confidential. You acknowledge that any reliance on material in email communications is at your own risk.

Turn to us for Disability Benefits, Medical Expenses, Lost Income, Future Income, Future Medical Care, Money for Your Pain, ICBC and Injury Cases. We can help!

Mouzourakis & Company
Nelson Square
1119 - 808 Nelson Street
Vancouver, BC
V6Z 2H2 Canada
Tel: 604-684-2664
Fax: 604-688-1579
info@mouzourakis.com

Mouzourakis & Company
Nelson Square, 1119 - 808 Nelson Street, Vancouver, BC V6Z 2H2 Canada
Tel: 604-684-2664 / Fax: 604-688-1579 / info@mouzourakis.com

Disclaimer: Materials on this web site have been prepared by Mouzourakis & Company, Trial Lawyers for general information purposes only. Although prepared by professionals, these materials should not be used as a substitute for legal advice in specific situations. You should not act or refrain from acting based on information at this site. These materials may be considered advertising in your state or province. The information provided at this site is not privileged and does not create a solicitor-client (attorney-client) relationship with Mouzourakis & Company, Trial Lawyers.