Injury Status Update

Secure Form

Please complete the form below to update your injury file. Answers should be completed with information since the date of your last Injury Status Update Form submitted to us. If this is your first Injury Status Update, please complete the form with information since the date of your consultation.

Have you had any doctor's appointments for your injuries? *

No
Yes

If yes, list the date of each appointment below.

Doctor's appointments since last update:

List the name of the provider and each appointment date.

Have you had any changes in your symptoms (improved, worsened, new symptoms developed)? *

No
Yes (describe changes below)

Describe any changes in your symptoms:

Have you had appointments for your crash-related injuries with any new doctors that you have not seen before? *

No
Yes (list new providers below)

List any new medical providers:

Have you had any new imaging (x-rays, MRI, CT-Scan, etc.)? *

No
Yes (List below)

List any new imaging you've had and where it was taken:

Have you received copies of any new medical bills related to your injuries? *

No
Yes

Have you received anything from your health insurance company related to your injuries? *

No
Yes

If you have received anything in the mail about crash-related medical expenses from a hospital, doctor's office, or insurance company, please email a copy to Brandi, or drop a copy off at an office location.

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First

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NEW CASE EVALUATION

First Name *

Last Name *

Email *

Phone Number *

Please Describe Your Case *

Name

EXPERTISE MATTERS

Attorney Keith Taylor is certified by the Florida Bar as an EXPERT in Civil Trial practice. The Florida Bar's board certification program sets high standards for lawyers. Attorneys who earn Florida Bar board certification have demonstrated their expertise and commitment to excellence in the practice of law.

Keith is the only civil trial specialist who is principally officed in Citrus County. Hire a lawyer with small-town attention and big-time experience.

Get in Touch

Mailing Address
P.O. Box 2016
Lecanto, FL 34460

Fax Number
(352) 795-3145

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OUR LOCATIONS

Crystal River
1143 N. Lyle Ave.
Crystal River, FL

Dunnellon
12017 S. Williams Street
Dunnellon, FL

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