On The Job Injury

Please use the form below to give us as much information as you can about your injury. *Please note that completion of this form does not create an attorney client relationship.

On The Job Injury Questionnaire

How did you find out about Servant Law(required)

Name(required)

Telephone(required)

Address(required)

Email address

Name of Employer

In what county is your employer located?

What type of business is it?

What is your job?

What was the date of your accident?

How were you injured?

What body parts were injured?

When did you notify your employer of your injury?

Who did you tell and what is their position?

Tell us the names of the doctors you have seen for your injury.

Have you returned to work?

Yes

Have you applied for unemployment or social security?

Yes

Do you know who your employer's Workers' Compensation carrier is?

Are you in bankruptcy?

Yes

Do you owe child support?(required)

Yes

Is there anything else you want to tell us about your accident?

This field should be left blank

Please wait...

On The Job Injury

On The Job Injury Questionnaire

Frequently Asked Questions of Alabama Workers’ Compensation

The Dog at Home

Dangerous Dog Breeds

Playful Dogs

Citronella Candles

Submit the following for a free case evaluation.