Use the questions below to tell us about your case. We will then contact you to discuss the matter and set up an appointment.

Name:	(required)
Email:	(required)
Address:
City, State and Zip Code:
Phone:
I WAS IN AN AUTOMOBILE OR OTHER KIND OF ACCIDENT.
WERE YOU INJURED? YES NO WAS SOMEONE KILLED IN ACCIDENT? YES NO DID ANOTHER DRIVER CAUSE THE ACCIDENT? YES NO DID YOU CAUSE THE ACCIDENT? YES NO IF YOU CAUSED THE ACCIDENT DID YOU RECEIVE A TICKET? YES NO
I WAS INJURED ON THE JOB AND WANT TO FILE A WORKERS’ COMPENSATION CLAIM.
WERE YOU INJURED ON THE JOB? YES NO DO YOU WORK FOR A MARYLAND EMPLOYER? YES NO DID THE ACCIDENT OCCUR IN MARYLAND? YES NO ARE YOU MISSING TIME FROM WORK? YES NO ARE YOU RECEIVING MEDICAL CARE? YES NO IS YOUR EMPLOYER PAYING YOUR MEDICAL BILLS? YES NO
I WAS ARRESTED FOR DRUNK DRIVING.
DID YOU TAKE A BREATHALYZER TEST? YES NO WERE YOUR BREATH TEST RESULTS .15 OR GREATER? YES NO IS THIS YOUR FIRST OFFENSE? YES NO ARE YOU EMPLOYED?  YES NO DO YOU NEED YOUR LICENSE FOR WORK? YES NO DO YOU ATTEND SCHOOL? YES NO DID YOU REQUEST AN MVA HEARING WITHIN 30 DAYS OF YOUR ARREST? YES NO WAS AN ACCIDENT INVOLVED? YES NO IF AN ACCIDENT WAS INVOLVED WAS ANYONE HURT? YES NO WERE YOU CHARGED WITH ANY OTHER TICKETS OR CRIMES AS A RESULT OF THE ARREST? YES NO
I WAS CHARGED OR ARRESTED WITH A CRIMINAL OFFENSE.
WERE YOU CHARGED WITH A MISDEMEANOR? YES NO WERE YOU CHARGED WITH A FELONY? YES NO WERE DRUGS INVOLVED? YES NO WERE YOU CHARGED WITH A VIOLENT ACT (EX: ASSAULT, RAPE, ARMED ROBBERY)? YES NO WERE YOU CHARGED WITH A THEFT CRIME (EX: BURGLARY, BAD CHECKS, SHOP LIFTING)? YES NO IS THIS YOUR FIRST CRIMINAL OFFENSE? YES NO ARE YOU EMPLOYED? YES NO ARE YOU MARRIED? YES NO DO YOU HAVE CHILDREN? YES NO
I AM HAVING FAMILY LAW PROBLEMS
ARE YOU MARRIED? YES NO DO YOU HAVE CHILDREN? YES NO ARE YOU FIGHTING OVER THE CUSTODY OF CHILDREN? YES NO ARE YOU FIGHTING OVER THE SUPPORT OF CHLDREN? YES NO ARE YOU THE VICTIM OF ABUSE AND WANT TO OBTAIN A PROTECTIVE ORDER? YES NO ARE YOU ACCUSED OF DOMESTIC VIOLENCE AND HAVE BEEN ORDERED OUT OF YOUR HOME? YES NO ARE YOU SEPARATED FROM YOUR SPOUSE? YES NO ARE YOU FIGHTING OVER ALIMONY? YES NO ARE YOU EMPLOYED? YES NO IS YOUR SPOUSE EMPLOYED? YES NO DO YOU OWN A HOUSE? YES NO
I AM INTERESTED IN MEDIATION SERVICES. YES NO
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Appointments are available in our offices on Main Street in downtown Westminster MD or we can visit you in your home, office or hospital in Carroll County, Maryland, Frederick, Baltimore County and other areas of Maryland.  All information submitted will be kept confidential and is only for purposes of lawyer / attorney review of case.