Houston Office 3200 Travis, 3rd Floor Houston, TX 77006 713-529-0025 713-751-0412 | Galveston Office 409-762-9090 888-529-4688 Home Attorney Profile Contact Us Chemical Plant Explosions Burn Injury Lawsuits Contact Us Contact Us Title —Please choose an option—Mr.Mrs.Ms.Mr & Mrs.Dr. First Name* Last Name* Relationship* Email* Phone* Alternate Phone Address City State —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip How would you prefer to be contacted?* EmailPhoneMail Name of who sustained burn injury? Date of Birth of burn victim? Date Accident occurred? Did the injury result in death? YesNo Did the injury result in loss of work? YesNo Did the injury require additional medical surgery? YesNo Please provide any additional comments: