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Are you the victim of an accident or an assault?
Answer these questions (all confidential) and our law firm will contact you if we can assist you. This data is protected by professional secrecy.
10
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1
Firstname and family name
*
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2
Email
*
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exemple@exemple.com
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3
Phone number
*
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4
Where do you live in the Paris region?
*
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75
94
92
95
93
91
78
77
other
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5
You are a victim of:
*
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a road accident
a crime
a work accident
a sports or life accident
other
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6
Have you been hospitalized?
*
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yes
no
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7
Have you had surgery?
*
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yes
no
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8
Have you had any rehabilitation sessions?
*
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yes
no
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9
Did you have a work stoppage?
*
This field is required.
less than a month
1 to 3 month
3 to 6 month
6 to 12 month
up to 12 month
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10
Describe your situation in a few sentences
*
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quote
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