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Free Case Evaluation

We will provide you a free review of your case

By providing us some general details of your case, we will be able to ensure we have no conflict of interest in representing you. Everything you include will be helpful and kept confidential. Please note that submitting your inquiry does not constitute an attorney/client relationship.

We will get back to you as soon as we can. If you want immediate assistance, call us today in Tulsa area at 728-8888 or use our toll free number 800-980-9205.

Please fill in all required fields (indicated by the asterisk symbol) then click the “Submit” button. Thank you.

Full Name (required)

Date of Birth

Street Address (required)

City (required)

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Zip (required)

Email (required)

Home Phone (required)

Other Phone

Marital Status
 Single Married Divorced Widowed

Name of Spouse

Occupation

Case Overview

City Injured In

State Injured In

Name & Address of Persons or Entities You Feel
Caused This Injury

Description of Injuries

Description of Treatment

Still Being Treated
 Yes No

If Yes, What Kind of Treatment Are You Now Getting
And/Or Do You Anticipate in the Future?

Approximate Cost of Medical Bills

Were You Forced To Miss Work?
 Yes No

Approximate Amount of Lost Wages or Benefits

Were You Contacted By An Insurance Company?
 Yes No

Description of Insurance Company Contact

Are You In Contact With Another Lawyer?
 Yes No

If So, Please Provide the Attorney's Name, Address
and Phone Number

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  • Law Offices of Jeff Martin on Linked In
  • Law Offices of Jeff Martin on Linked In