Families OLD

Thank You for reaching out to our agency - and our condolences in the loss of your loved one.

Please complete this intake form and one of our principle experts will call you to review the details.

(Complete all areas - if you cannot, please place N/A in the field)

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Relationship to Decedent *

Is this for current or potential litigation? *

Have you or will you retain an attorney? *

Decedent's Name *

Decedent's Birthdate *

Decedent's Date of Death *

Cause of Death on the Death Certificate (what action resulted in the death) *

Manner of Death on the Death Certificate *

Was there a Law Enforcement investigation> *

Was there a Medical Examiner / Coroner Investigation? *

Was there an Autopsy *

Was there Toxicology *

Do you have any of the above Records, Reports, and Photographs? *

Synopsis of Death and Familial Concerns *

How did you hear about us? *

Upload File *

Max file size: 20MB

- Records and Reports
- Death Certificate
- Additional Documents
- DO NOT send photographs

Submit

We thank you for considering our agency for to address your concerns in your loved one's questioned death.
Please accept our deepest condolences in your loss.

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