Charles M. Brewer, LTD | Personal Injury Law

Use this email form to obtain a free consultation about your potential wrongful death, aviation, design negligence or products liability case. We should respond to you on the same day. If you prefer, you may download the Case Information Form using the link below, fill it out with as much information as you can, than mail it to us. Additionally, you may speak directly to someone in our office by calling 602-381-8787 or toll free at 800-381-8780. To expedite your case evaluation, we encourage you to provide us with at least your name and phone number, so that one of our attorneys or staff memebers can contact you to get any additional information that may be needed.

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FULL NAME:

DATE OF BIRTH:

HOME PHONE:

MOBILE PHONE:

EMAIL:

ADDRESS:

STATE THE LOCATION (CITY & STATE) WHERE THE INJURY OR EVENT OCCURED:

DEPENDANT(S):

DEFENDANT(S) OR PARTY AT FAULT:

Describe the accident or event in question, but do not include any confidential information. If you think we need to consider any confidential information, please call us at 602.381.8787 or you may use our toll free number 800.381.8780. If convenient, you may also email us at cmbrewer@cmbrewer.com.

Date of the Injury:

Describe the Injury:

DOCTORS/HOSPITALS:

Disclaimer: Using this website or sending us email does not create a binding contractual relationship with this firm. This website and the Case Information Form have been prepared by Charles M. Brewer, Ltd. for potential representation and evalulation only. Any information you provide will be confidential and not disseminated to anyone.