R. Michael Smyrl - Attorney At Law

office (713) 947-0001
fax (713) 947-9113

3009 Strawberry
Pasadena, TX  77502

Tell Me About Your Accident

Date and Time of Accident:
Home Telephone:
Cell Telephone:
Your Insurance Company:
Insurance Adjuster Contact:
Location of Accident:
Description of Accident:
Describe your Injuries:
Doctor Names:
Losing Time from Work:
Police Report:
Ticket Issued:

The Other Driver Information

Telephone Number:  
Insurance Company Name:  
Insurance Contact Information:  
Insurance Adjuster:  
Claim Number:  

Important Information

The facts requested are the bare necessities that I would need to make a preliminary opinion on your case. Naturally if you cannot provide all the information requested I will be happy to review the information you have at present. Any communications of fact you make to me concerning your accident would be subject to the "Attorney/Client" privilege and would not be divulged to anyone without your consent. Once the information is provided I will endeavor to contact you as soon as possible.