Ohio Workers’ Compensation Lawyers

Case Submission Form

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    Full Name*
    Date of Birth
    Street Address*
    Zip Code*
    Home Phone*
    Other Phone
    Marital Status
    Name of Spouse
    Case Overview
    City Injured In
    State Injured In
    Name & Address of Persons or Entities You Feel
    Caused This Injury
    Description of Injuries
    Description of Treatment
    Still Being Treated
    If Yes, What Kind of Treatment Are You Now Getting
    And/Or Do You Anticipate in the Future?
    Approximate Cost of Medical Bills
    Were You Forced To Miss Work?
    Approximate Amount of Lost Wages or Benefits
    Were You Contacted By An Insurance Company?
    Description of Insurance Company Contact
    Are You In Contact With Another Lawyer?
    If So, Please Provide the Attorney's Name, Address
    and Phone Number

    Contact Information

    Dayton Office

    3033 Kettering Blvd #201
    Dayton, OH 45439

    Toll Free: 877-623-6863
    Local: 937-684-4607
    Fax: 937-228-0508

    Get Directions

    Cincinnati Office

    2060 Reading Rd
    Suite 240
    Cincinnati, OH 45202

    Toll Free: 877-623-6863
    Local: 513-276-4022

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    Springfield Office

    20 S Limestone St #340A
    Springfield, OH 45502

    Toll Free: 877-623-6863
    Local: 937-688-2551

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    Troy Office

    2826 Stone Cir Dr
    Troy, OH 45373

    Toll Free: 877-623-6863
    Local: 937-524-0115

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    Columbus Office

    2 Miranova Pl #390
    Columbus, OH 43215

    Toll Free: 877-623-6863
    Local: 614-699-5970

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