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<p><span class="wpcf7-form-control-wrap full-name"><input type="text" name="full-name" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false" placeholder="Full Name *" /></span></p>
<p><span class="wpcf7-form-control-wrap phone-number"><input type="text" name="phone-number" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false" placeholder="Phone Number *" /></span></p>
<p><span class="wpcf7-form-control-wrap your-email"><input type="email" name="your-email" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email" aria-required="true" aria-invalid="false" placeholder="Email *" /></span></p>
<p><span class="wpcf7-form-control-wrap case"><select name="case" class="wpcf7-form-control wpcf7-select wpcf7-validates-as-required" aria-required="true" aria-invalid="false"><option value="">How Can We Help You?</option><option value="Motor Vehicle Accident before April 1, 2019">Motor Vehicle Accident before April 1, 2019</option><option value="Motor Vehicle Accident after April 1, 2019">Motor Vehicle Accident after April 1, 2019</option><option value="Medical Malpractice">Medical Malpractice</option><option value="Occupier’s Liability (Injury on Private Premises)">Occupier’s Liability (Injury on Private Premises)</option><option value="Sporting/Recreational Accidents">Sporting/Recreational Accidents</option><option value="Protecting Public Interest Speech">Protecting Public Interest Speech</option><option value="Other">Other</option></select></span></p>
<p><span class="wpcf7-form-control-wrap info"><textarea name="info" cols="40" rows="10" class="wpcf7-form-control wpcf7-textarea" aria-invalid="false" placeholder="Case information including date"></textarea></span> </label></p>
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<p class="holness-note">* Lawyer confidentiality assured</p>
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