The Law Offices of Kenneth M. Rodgers

Your Philadelphia Injury Lawyer
Helping victims for over 40 years.

Are you injured?

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1(215) 923-3330

This form is provided for you to help me in evaluating your claim. Please submit it with as many details as possible. If you experience any difficulty with this form, please contact me at krodgers@lawrodgers.com or by phone at 215-923-3330.

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Untitled Document

Your name*
Street address
City
State
Zip
Phone*
Email
Date of Injury (approximate -- dd/mm/yyyy)
Type of injury (i.e. broken ankle, back injury, etc.)*
Where did the injury occur
Parties you believe to be responsible and why
What action other lawyers have taken about your potential claim
Medical care to date
Time missed from work as a result of the injury