Law Offices of Jim Lewis - Atlanta, GA

For more information on our services print, fill out, and fax the following form to us at: (404) 681-3816.

Client Name:
Date of Incident:

Case Information
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Accident Location:
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Case Assigned To:
Reassigned To:

Party Entry (Client):
Name:
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Date of Birth:
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Address:
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Home Phone:
Work Phone:
Driver's License No.:
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Prior Accident Claims:
Prior Disabilities:
Marital Status:
Spouse's Name:
Nearest Relative Name:
Nearest Relative Relation:
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Telephone:
Client Referred By:
Activity When Injured:
Employed:
Employer:
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How Long Employed?
Address of Employer:
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Hours: Monday - Friday 8:30 am - 6:00 pm
Saturday 11:00 am - 2:00 pm

Member Atlanta Bar Association, Dekalb Bar Association

Free Parking Behind Our Building
Evening and Weekend Appointments Available

Law Offices of Jim Lewis
427 Moreland Avenue NE • Atlanta, GA 30307
(404) 681-3815 • Fax: (404) 681-3816
E-Mail Us At: attorneyjimlewis@mindspring.com
To Send E-Mail to Our Cell Phone:
4047871347@page.nextel.com

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