Address
421 West Riverside, Suite 654
Spokane, Washington 99201
Phone: 509-838-2425

Contact Us

It is our preference that you call us to discuss your case. The information that we need initially is outlined below. Please review and prepare your answers, and then either call us or submit the information by fax, email or regular mail. Thank you.

* Name

* Address

* Daytime Phone

* Evening Phone

Name of injured party:

Date of birth of injured party:

The Injured Party is:

If other, please explain:

This is a claim involving: (check all that apply)

Doctor(s)
Clinic
Hospital
Nursing Home
Other

Doctor(s) Name

Doctor(s) City/State

Clinic Name

Clinic City/State

Hospital Name

Hospital City/State

Nursing Home Name

Nursing Home City/State

Other Name

Other City/State

* The approximate date(s) of care, treatment, death or injury are: (include month and year)

Please provide a brief description of what you believe was an error or mistake:

Are there any long-term or permanent injuries or problems which you believe are a result of mistakes by healthcare providers?

Yes
No

If yes, please explain:

Have you lost income or the ability to work or earn?

Yes
No

If yes, please explain:


* Please enter the security code shown below:

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Quick Contact
 
Kenneth H. Coleman: Washington Attorney, Medical Malpractice, Wrongful Death
Address
421 West Riverside, Suite 654
Spokane, Washington 99201
Phone: 509-838-2425

Contact Us

It is our preference that you call us to discuss your case. The information that we need initially is outlined below. Please review and prepare your answers, and then either call us or submit the information by fax, email or regular mail. Thank you.

* Name

* Address

* Daytime Phone

* Evening Phone

Name of injured party:

Date of birth of injured party:

The Injured Party is:

If other, please explain:

This is a claim involving: (check all that apply)

Doctor(s)
Clinic
Hospital
Nursing Home
Other

Doctor(s) Name

Doctor(s) City/State

Clinic Name

Clinic City/State

Hospital Name

Hospital City/State

Nursing Home Name

Nursing Home City/State

Other Name

Other City/State

* The approximate date(s) of care, treatment, death or injury are: (include month and year)

Please provide a brief description of what you believe was an error or mistake:

Are there any long-term or permanent injuries or problems which you believe are a result of mistakes by healthcare providers?

Yes
No

If yes, please explain:

Have you lost income or the ability to work or earn?

Yes
No

If yes, please explain:


* Please enter the security code shown below:

Captcha Image

      

Quick Contact