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Case Form

Initial Case Submittal Form (Oprima aqui por la version en Espanol de la Forma Inicial al someter el caso.) Use this Initial Case Submittal Form to provide the information we need to schedule your Free Consultation concerning your potential injury case. We should respond to you on the same day or the next business day. Please call (480) 706-1100 or 1 (877) 6-HASTINGS if you prefer to speak directly to someone in our office.
First Name of Injured Person
Last Name of Injured Person
Address of Injured Person	Zip Code
Home Phone Number	( ) -
Alternate Phone Number	( ) -
Email Address
Type of Accident	Motor Vehicle Dog Bite Slip and Fall Other
Location of Accident	In Arizona Outside Arizona
Please provide a brief description of your accident-related injuries and the facts of the accident (event) which lead to your injuries
If you proceed with the submission of this form, you confirm that you have read and understand the Internet Email Notice. Please call (480) 706-1100 or 1 (877) 6-HASTINGS if you prefer to speak directly with someone in our office.

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