Experienced Nursing Home Abuse Attorneys - Do you have a case?

Please take a few moments to fill out the form below. Attorneys at Wilkes & McHugh, P.A. will use this information to contact you. If you have been injured due to the fault of another — even partially — this form can help our attorneys determine if you have a claim.

At Wilkes & McHugh, P.A., we value your privacy. We will not share any of this personal information with a third party without consulting you first.

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First Name: *

Middle Initial:

Last Name: *

Name of Injured Person:

Address 1:

Address 2:

City:

State:

Zip:

Primary Phone Number or Email Address: *

Required if you want someone to contact you.

Secondary Phone Number:

Do you already have a lawyer retained for this matter?

Yes

Are you 18 years of age or older? *

Yes

Are you the victim?

Yes

Would you like an attorney to contact you regarding this matter?

Yes

Please describe the injury. Give as much information as possible — no detail is too small. Also, if you would like us to contact you by email, please include your email address below.

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