Kava Kava Injury Contact Form

If you believe that you or someone close to you may have a personal injury claim related to the Kava Kava, please fill out the following questionnaire. By submitting the information below, you will enable the attorneys at the Saunders & Walker, P.A. to evaluate your case based on its merits. Please be as complete as possible in the information you provide.

If you would like to contact Saunders & Walker, P.A. for reasons other than a possible personal injury claim, please send an e-mail to joe@saunderslawyers.com.

There is no charge for this evaluation

General Contact Information

Full Name: Street Address: Street Address 2: City: State:		E-mail Address: Phone Number: Work Number: Fax Number: Zip:
What method would you prefer we use to contact you? What time of day would you like us to call?
If you are inquiring on behalf of another person, please give their name and answer the following questions on their behalf:

Kava Kava Injury Questionnaire

Sex Male Female
Name of person:
Birthdate:
Relationship to you:

Any additional comments?

Important Legal Disclaimers

Yes No - I agree that the information that I will receive in response to the above question is general information and I will not be charged for the response to this e-mail question.

Yes - I agree that the above does not constitute a request for legal advice and that I am not forming an attorney client relationship by submitting this question. I understand that I may only retain an attorney by entering into a fee agreement, and that I am not hereby entering into a fee agreement.

By Clicking the appropriate box below, I agree to: