With over fifty years of protecting the rights of the individual, Wagner, Vaughan & McLaughlin is one the foremost client advocacy firms in the nation. We would be honored to review your case and, if taken, to fight vigorously for you.
 

Personal Injury Free Case Evaluation Form

We are willing and eager to evaluate your potential personal injury or wrongful death case and discuss its merits and value with you. There is no charge for our preliminary evaluation and discussion, but we do need certain information from you to perform our evaluation. The quality of our evaluation is dependent upon the accuracy and fullness of the information you provide to us. Once we receive the information requested below, we will contact you to discuss our evaluation.

Your full name:

E-mail Address:*

Mailing Address:

 

 

Home Number:

Work Number:

Best time to reach you if you prefer a response by telephone:

How would you like for us to respond to you (e.g., telephone, e-mail, regular mail, doesn't matter)?

Please provide the name and age of the injured or deceased person, as well as your relationship to that person (if the injured person is someone other than you)

What was the date of the injury or death?

Where did the injury or death occur (City, State)?

Describe the accident which caused the injury or death as fully as possible:

Who do you believe was at fault in causing the injury or death, and what do you believe that person or company did wrong?

If death has occurred, please answer questions A through C below. If serious injury short of death has occurred, please answer questions D through E.

A. Has probate begun or an estate been opened and, if so, who is the personal representative of the estate?

B. What are the names, ages, and relationships of the deceased's nearest relatives (spouse, children, parent, etc.)?

C. Was the deceased person working before the negligence which caused his or her death and, if so, how was the person employed and approximately how much did they earn per year?

D. Describe the injuries suffered by reason of the negligence. If you know, state whether you believe the injury is permanent. What are the total medical bills to date?

E. Have you (or the injured person, if other than you) lost any earnings? Are you still off work? What kind of work do you do, and how much do you earn per week or per month?

Would you like to arrange a personal interview?

Is there any other information that you want to provide us?

If you are finished, agree with the above, and want to send this information by e-mail:

If you want to start over to correct or change information:

INTERNET SECURITY: Sending information over the internet is not always a secure way to send information. While we will keep the information you send us over the internet CONFIDENTIAL once it is received in our office, we cannot be assured that it will be secure while being transmitted to our office. If you have any concerns about that, please print the information above and mail it to us at:

Wagner, Vaughan & McLaughlin, P.A.
601 Bayshore Boulevard
Suite 910
Tampa, Florida, 33606

THE SERVICE WE PROVIDE: When we receive the information you have provided, we will evaluate the information and then contact you (in the manner you have requested) to tell you:

a. Our preliminary evaluation of the merits of your case
b. Whether we would be willing to represent you.

Obviously, the information you have sent us may not be sufficient to provide full answers to the above matters. If more information is needed, we will contact you to obtain the necessary additional information before we give you our evaluation of your potential claim.

We will try to be in touch with you within a short period of time. We are an active law firm with many trials, however, and on occasion the requirements of providing service to our current clients may cause us to delay answering your inquiry. If you do not hear from us within a reasonable time, don't hesitate to call. Under most circumstances, you should expect to hear from us within two days of our receipt of your inquiry.

OUR FEES: We charge no fee to provide the limited service described above. If you decide to employ our firm to represent you, we will provide contracts for you to read and sign. We also suggest you read the "Protecting Your Rights" tab on this site. If we represent you, we are willing to do so on a "Contingent Fee" basis, that is, you will owe us no fee for our services unless we make a recovery for you, and in the event of a recovery, your fee will be a percentage of the amount recovered, as outlined on this site and in the written contract we will provide to you.

LIMITATIONS ON OUR SERVICE:

  1. The advice we provide is obviously limited by the information you provide to us. Final advice would be based upon a complete evaluation of your entire case. This cannot be accomplished with the limited information you have given us above. Often a full evaluation of a claim cannot be given without collecting considerable information, records, and other investigation. Often a decision about a claim can only be made after a personal interview.
  2. Your claim may be barred by one or more Statutes of Limitations. These statutes provide that if a suit is not brought within a certain amount of time, the claim can never be thereafter brought. Likewise, the information you furnish may be furnished at a time so close to expiration of the statute of limitations that we do not have time to provide any help to you before the time expires. By asking for our help, you agree that we are not liable for failing to file suit on your behalf or failing to take any other action on your behalf.
  3. You are not obligated to employ this firm by sending this information. Likewise, we are not obligated to accept you as a client by providing this help to you. We reserve the right to decline to represent you for any reason whatsoever. Once we have provided the limited service mentioned above, we reserve the right to refuse to become involved in further evaluation of your claim or in providing further advice. If we decline to represent you, or to provide additional advice, we will so advise you in writing at the address you have given us.

ADDITIONAL SERVICES: We are available to provide additional advice and services upon written or telephoned request unless we advise you of our decision not to do so as outlined above. Please feel free to write us at our Bayshore Office if more information is needed. It always helps to send along as much information as you have to help us help you.