Pre-Litigation Forms

You are only required to fill out the fields highlighted in yellow in the forms below.

WAGE LOSS INSTRUCTIONS
If you have missed any time from work due to the injuries that you have sustained (i.e. non-paid/paid, PTO, sick days, etc.), please kindly have your employer complete the “Wage & Salary Verification form” and have your treating physician complete the “Attending Physicians Report.” We will need both forms completed in order to include any lost wages as a part of your claim.

1. Wage and Salary Verification
2. Attending Physician’s Report

Please provide us these forms after you complete them by submitting below.