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Have you or your loved one received any settlement money from this claim? *

Was the injury due to someone else's negligence? *

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I understand that submitting this form and the information contained herein does not constitute a Consultant/Attorney/Client relationship. I understand the response to the above question is general information and I will not be charged. I understand that state laws may vary, and therefore, I will not rely upon this information as legal advice. Since this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter. *

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