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Fehseke & Eschman Law Offices

1023 Avenue G
Fort Madison, IA 52627-4579
Phone: (319) 372-7181
Fax: (319) 372-7185
info@fehsekelaw.com
 

Free Case Evaluation

If you would like a free case evaluation or if you would like one of our lawyers to contact you, please fill out the following Case Evaluation form.

Fehseke & Eschman Law Offices does a conflict of interest check on incoming submissions, initially viewing only name, address, e-mail address, telephone number and names of the opposing parties. If there is a conflict, all other information will be deleted and representation will not be provided. We will attempt to inform you if we discover a conflict. We also reserve the right to decline representation for any reason.

Mere submission of the Case Evaluation Form does not create an attorney/client relationship. The mere fact that there is no conflict does not create an attorney/client relationship or representation.

Please provide the following information about the injured person:


NOTE:  An Asterisk (*) Indicates REQUIRED Information.

*Full Name:
Home Address:
City, State & Zip:
Work Phone:
Home Phone:
*E-mail Address:
 
Names of Person(s) Who Caused the Injury or Accident:

Date of Injury or Accident:
Place where the Injury or Accident Occurred:

Description of the Injury:

What Happened to Cause Injury:

Date of Birth of the Injured Person:
Social Security Number of the Injured Person:
Any Additional Facts That You Think We Should Know Now:


The use of the Internet for communications with the firm will not establish an attorney-client relationship and messages containing confidential or time-sensitive information should not be sent.

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