Personal Injury Intake Form

Start Your Case with Confidence

Thank you for reaching out to Florida Civil Counsel, P.A. We understand that suffering an injury can be a difficult and overwhelming experience. This intake form allows us to collect essential information about your case—whether you’ve experienced a car accident, dog bite, negligent security incident, or other personal injury—so our dedicated legal team can begin evaluating your situation promptly. The details you provide help us understand your circumstances and determine how we can best fight for the compensation you deserve.

Whether you were involved in a car accident, workplace injury, slip and fall, or another incident caused by negligence, completing the form ensures we have the critical facts to start building your strategy.

What to Expect:

• A quick, secure submission process
• No obligation or upfront commitment
• A confidential review by our legal team
• Faster case evaluation and next steps

Your story matters. Let’s start building your case the right way.