Case Evaluation

Please fill out the following for a free case review. The information submitted will be accorded the utmost confidentiality. This information is necessary in order to do a conflict of interest check before responding to you. Please provide the following information for the person in need of assistance. Fields with (*) are required.

*Full Name


*Home Phone

Injury Cases

If you need assistance with an injury matter (including wrongful death claims, product liability claims and malpractice claims) please submit the following information as well.

*Date and Place of Injury

How were you injured?

*Please describe your injuries

Please describe any treatment you have had so far

What is the best time to contact you?

What is the best way to contact you? (e-mail, phone, letter)

After the information is complete, please press the submit button. Mr. Buchta will review the information and contact you within 24 hours with his evaluation