Case Evaluation Form

If you or a family member has suffered injury, neglect, or abuse at the hands of someone charged with their care, we may be able to help. Please fill out this form and send it to us to tell us more about your case.

Note: An asterisk (*) indicates required information.

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* Name:
* Phone number:
* Address:
* E-mail:
* Date(s) of injury or event:
* Briefly describe the injury or event:
* How did you hear about David P. Moody?
* I understand and agree that submitting this form does not create an attorney-client relationship and that the information I submit is not confidential or privileged.  Agree