Jury Consulting Attorney Input Form
Law Firm Name
Attorney Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Case Name
Jurisdiction (County/State)
Alleged Injury(ies)
HOW MANY JURORS ARE EXPECTED TO BE IN THE PANEL
Date of Loss
Statement of the Case (Defense Issues / Plaintiff’s Issues)
Amount of Medical Damages (and/or non Medical) Seeked
File Upload - Please add claim forms, Complaint, Answer, incident/complaint records, MVA collision reports, photos, etc. Accepted file types .pdf, .doc, or .jpeg UPLOAD FILES - If over 25 MB total then please email a link with all documents to: denisse@asaptrialtech.com
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Jury Consulting Service Client Input Form
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