"Thank you for calling The Sharma Law Firm, this is {name}, how can I help you?"

Any details included in the response to this question should be added to the 'Additional Details' field at the end

"I'm sorry this happened. I need to gather some information for the attorneys to see how they can better assist you. May I have your first and last name please?"

Primary Contact Information

Caller First Name *

Caller Last Name *

Primary Contact Phone Number *

Caller ID Phone Number *

Primary Contact Email *

Address *

Street Address *

State *

City *

Zip code *

Is the caller also the potential client? *

Are you the affected person, or are you calling on someone else's behalf?

Alternate Contact Information

Client First Name *

Client Last Name *

Client Contact Phone Number *

Best time to reach the contact person? *

Primary language of the Caller: *

English

Spanish

Other

Incident Information

Case Type *

Select the Case Type

Date of Incident *

Name of Employer *

Where did the Incident Happen? *

Summary of Incident *

Injuries Sustained *

Hospitalization or Medical Attention? *

Hospitalization

Medical Attention

None

Did they report the incident to the police? *

Yes

Was anyone issued a ticket by the police?

Yes

Who was issued a ticket and for what?

Did they report the incident to anyone else? *

Yes

Who did they report the incident to? *

Did they report the incident to their employer? *

Yes

Have they consulted with another attorney? *

Yes

Additional Details

How did you hear about the Sharma Law Firm? *

Standard Call Ending:

"Thank you (Caller's Name) for contacting The Sharma Law Firm. I’m going to send all this information over to the attorneys now for their review and they will call you back within 24 hours."

"Is there anything else I can do for you?"

"Thank you again for calling, have a great day/night."

Medical Malpractice Call Ending:

"Thank you for calling The Sharma Law Firm. At this time, the firm is not accepting new medical malpractice cases. We encourage you to continue your search, and we wish you the very best in finding the right representation. Thank you again for reaching out, and have a great day."