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Serious injuries caused by negligence inevitably lead to legal issues. Get the help you need by contacting Howie Sacks & Henry LLP. Our law firm has served the Greater Toronto Area (GTA) for more than 30 years. We practice personal injury law exclusively and we are dedicated to providing the highest standard of legal services in Ontario.

To arrange a free consultation with one of our highly experienced lawyers, please complete the online consultation form or call 877-695-9440 or 416-361-5990.

Click here to find our full staff listing and their contact information.

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Client Information

Name

Street Address

City

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Home Phone

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E-mail Address Please enter a valid e-mail address.

How did you hear about our firm?

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Referral

Is this form in reference to yourself or a third party?

Myself

Third Party

If a third party, what is your relation to the individual?

Case Type

Motor vehicle collision
Workplace or work-related accident
Sports or recreational accident
Medical, nursing, or other professional malpractice
Slip and Fall
Assault
Other (Please Describe)

Date of illness or injury Date of illness or injury

Please describe how the accident happened

Were you taken to the hospital?

Yes

No

What are your injuries?

What medical treatment have you received?

Are you currently receiving medical treatment?

Yes

No

Do you have any significant pre-existing medical conditions?

Yes

No

If yes, please expand:

Case Information

Are you currently represented by another law firm?

Yes

No

Has a law suit been commenced already?

Yes

No

Were you employed at the time of your injury?

Yes

No

If yes, please describe your occupation and your approximate income:

What was the last day you worked? What was the last day you worked?

How many years did you work before impairment? How many years did you work before impairment?

Do you require supervision or assistance to care for yourself?

Yes

No

If yes, please describe the care you are receiving:

Have you applied for Long-term or Short-term disability?

Yes

No

Have you been approved for LTD or STD?

Yes LTD

No LTD

Yes STD

No STD

Have you returned to work?

Yes

No

Please provide any other information or concerns:

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• Car Accidents
• Truck Accidents
• Motorcycle Accidents
• Bike and Pedestrian Accidents
• Accident Benefits Claims
• Recreational Vehicle Accidents
• Public Transportation Accidents
• Boating Accidents
• Slip and Fall Accidents
• Product Liability Injuries
• Long-Term and Short-Term Disability
• Spinal Cord Injuries
• Traumatic Brain Injuries
• Medical Malpractice
• Birth Injuries
• Fatal Accidents
• Nursing Home Negligence
• Brachial Plexus Injuries
• Cerebral Palsy
• Surgical Injuries