Myers Law Office LLC
8420 Dorchester Road Suite 202
North Charleston, SC 29420
843-279-4396
Accident Type:
Select an option
Car Accident
Truck Accident
Boat Accident
Motorcycle Accident
Slip and Fall
Hurt On The Job
Medical Malpractice
Wrongful Death
Only Property Damage
Other
Were you at fault or ticketed for the accident?
Yes
Which Law Enforcement Arrived?
No
Which Law Enforcement Arrived?
Did you seek medical care?
Yes
Which Medical Facility/Provider?
No
Are you currently represented by an attorney, or has your claim been declined by one?
Yes
Which Attorney/Firm?
No
Location where the accident/injury occurred?
When did this happen?
Select an option
0 - 6 months ago
6 - 12 months ago
1 - 2 years ago
2 - 3 years ago
Contact information
Prefix
First name
*
Middle name
Last name
*
Emails
Address
*
Type
Upon submission, a copy of this form will be sent to the primary email.
Work
Home
Other
Primary
Default email false
Add email
Phone Number
Upload Document/Reports/Etc
Add attachment
Add attachment
Choose file
This file could not be attached because it exceeds the 50MB limit.
Please choose a file.
Cancel
Upload