Fairfax, Virginia Attorneys At Law
Fairfax, Virginia Attorneys At Law 703-218-1300.
Auto Accidents Information

Motor Vehicle Accidents Contact Form

Name

Address

City

State

Zip

Email Address

Phone Number

When and where did the accident occur?

What were the conditions? Light/Dark? Wet/Dry? Snow/Ice?

Where were you in the vehicle? Were you driving?

Who owns the vehicle?

Is the vehicle insured?
Yes  No 

Please describe how the accident happened.

Did the police come to the scene of the accident?
Yes  No 

If so, do you have a copy of the police report?
Yes  No 

Were any citations issued or arrests made?

Do you believe that alcohol was a factor in causing the accident?

Were you injured in the accident?
Yes  No 

Were you taken to the hospital?

What medical treatment have you received?

Are you currently receiving medical treatment?
Yes  No 

Was the other driver injured?
Yes  No 

Were any passengers injured?
Yes  No 

Please list any other concerns.

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Licensed to practice law in Virginia, Maryland and the District of Columbia.
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4085 Chain Bridge Road, Suite 500 Fairfax, VA 22030 T: 703-691-8333 T: 703-218-1300 F: 703-691-8380

KFFJ, PLLC provides high quality legal services to people who are faced with personal injury, wrongful death, family law or criminal law concerns. Our Northern Virginia lawyers serve the entire Washington Metropolitan area, including: Fairfax, Alexandria, Vienna, Herndon, Manassas, Woodbridge, Leesburg, Chantilly, Centreville, Falls Church, Fredericksburg, Warrenton, Fauquier, Culpeper, Reston, Sterling, Oakton, Great Falls, McLean, Fairfax Station, Springfield, and Burke, as well as Quantico Marine Base, Fort Belvoir, Fort Myer, and the Pentagon, as well as Rockville, Gaithersburg, Bethesda, Potomac, Oxon Hill, Lanham, College Park and all of the towns and cities in suburban Maryland.

Virginia: Fairfax County ▪ Arlington County ▪ Stafford County Prince William County ▪ Loudoun County ▪ Spotsylvania County ▪ Stafford County and the City of Alexandria

Maryland: Montgomery County ▪ Prince George's County ▪ Charles County ▪ Calvert County ▪ Anne Arundel County ▪ Baltimore County

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