Tell Us What Happened

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Information Form

Name*
First Last
Today's Date*
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Address
Please provide the address at which you would like to receive mail concerning the claim or case.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Cell Phone
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Email Address*
Name of Injured Party
Relationship to Injured Party
What happened?
Please describe the facts of the neglect or abuse.
Where did it happen?
Please provide the name, city, and state where the nursing home or assisted living facility is located.
Date of Incident*
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What were the injuries?
Please describe the injuries or results of the neglect or abuse.
How did you hear about us?
Acknowledgement Statement*
- I acknowledge that I have read the following statement:
This web site is a public resource provided for general information about our law office and the other topics addressed on this site. Laws develop over time and differ from state to state. Therefore, this site does not provide legal advice or services about specific legal problems, and the reader is cautioned not to use the information contained in this site for those purposes. Use of this site does not give rise to an attorney-client relationship. One of our attorneys will need to meet with you in person and we will each need to agree for my office to undertake legal representation before an attorney-client relationship can develop. Please contact our office to speak with someone directly to address your specific legal questions or concerns. Thank you.
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Visit Us

We are conveniently located in Central Virginia and represent patients and their families in the Roanoke, Lynchburg, Charlottesville, Richmond, Norfolk, and Danville areas and statewide across Virginia. Our address and contact information are as follows:

Unable to visit us? Contact us and we’ll come to you!

Appomattox Office

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Driving Directions

Telephone: (434) 352-4600
Toll Free: 1-877-337-6552
Telecopier: (434) 352-4601

Lynchburg Office

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Driving Directions

Telephone: (434) 847-8888
Telecopier: (434) 847-8886

Richmond Office

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Driving Directions

Telephone: (804) 690-0180
Toll Free: 1-877-337-6552
Telecopier: (804) 368-0078

About Us

Our law office has been serving Virginians since 1997 and is dedicated to protecting the rights of the victims of nursing home and assisted living neglect and abuse in Richmond, Roanoke, Lynchburg, Danville, Charlottesville, and across Virginia.