New York Personal Injury Attorneys

Law Offices ofMichael W. Goldstein
299 Broadway, 8th Floor, NY,NY 10007
Phone: (212) 571-6848 Toll Free: (877) I WAS HURT

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NY Accident Lawyer- No fee unlessyou recover money damages. Let a NY attorney review your case. Submit formor call toll free: 877 I WAS HURT for free telephone consultation. School Accidents, DangerousPlayground Accidents, School Bus Accidents, Camp Accidents, Injuries caused by Improper Supervision, MotorVehicle Accidents, Auto Accidents, Hit & RunAccidents, Uninsured Motorist Accidents, Serious InjuryAccidents, Taxi Accidents, Truck Accidents, Bus Accidents, Train Accidents

Welcome to Child Injury Lawyer'sPersonal Injury Questionnaire.

MichaelW. Goldstein, Esq. has been practicing New York personal injury law since 1979. If you or your child sustained a serious injury, such as a fracture or an injury requiringsurgery, please complete and submit the form below.

*MeansRequired Filed.

Please provide the following information regarding your injured child:
Name of Child:
Age of Child:
Your Relationship to Child:
Please provide the following information as it applies to you:
Name:
Address:
City, State, Zip:
Home Phone:
Work Phone:
Cell Phone (Optional):
*Email:**
Fax:
Date of Accident:
Location of Accident (Include City or Town):
Did the police respond to your child's accident? YesNo If so, do you have a police report? YesNo Was your child examined or treated at a hospital emergency room? YesNo Was your child hospitalized? Yes No Did your child see a doctor as a result of his or her injuries? YesNo Is your child currently under a doctor's care for injuries sustained in this accident? Ye No How much time, if any, did your child lose from school? Description of Accident: (Please include a description of what caused your child's accident, and who was at fault.)
Describe Your Child's Injuries:
For motor vehicle accidents, describe the damage to the vehicles:

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