Wrongful Death Case Evaluation

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Contact Information
*First Name:   
*Last Name:   
*Email Address:   
*Phone:   
Alt. Phone:   
Address:   
City:   
State/Province:   
Zip:   
 

Injury Information
Name of deceased person   
What is your relationship to the deceased?   
What was the cause of death?   
What was the date of injury or accident?   
Was there an autopsy performed?    YesNo
Where did the injury or incident occur?   
Who referred you to Johnson, Clifton, Larson & Schaller?   
 

Case Information
* Please add any additional information that you would like us to consider.

The Oregon personal injury trial attorneys at Johnson, Clifton, Larson & Schaller, P.C. represent plaintiffs in personal injury and wrongful death cases involving medical malpractice, motor vehicle accidents, truck accidents, disabled persons' tort claims, nursing home negligence or elder abuse, construction and industrial accidents, birth injury cases, and product liability and defective medical device cases. Our Eugene medical malpractice lawyers serve clients throughout central Oregon, southern Oregon, and the Willamette Valley, including Corvallis, Salem, Medford, Roseburg, Klamath Falls, Bend, Redmond, Ashland, Creswell, Central Point, Grants Pass, Brownsville, Myrtle Creek, Springfield, and Albany, OR.

Lane County ◦ Marion County ◦ Benton County ◦ Douglas County
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