Contact Des Moines Personal Injury Lawyer | Iowa Premises Liability Attorney

Contact Greg Peterson, Attorney at Law

For 30 years, Greg Peterson, Attorney at Law, has teamed with his clients to pursue the compensation they deserve for their personal injury, work injury or car accident injury. He offers accessible, responsive representation in every stage of your matter. For a free initial consultation with an experienced and accessible personal injury lawyer, please complete the form below or call us. Arrangements are available for a confidential meeting at a private location for incapacitated clients who are unable to travel to my law firm.

*Required to submit form

*Full legal name:
Address:
Date of Birth:
*Phone:
*Email Address:
Describe your injury:
Date, Time & Place of Injury:
How were you injured?
Please set out your injuries in detail:

Did you require an ambulance? If yes, which ambulance service did you use & which hospital were you taken to?:
Who is your primary doctor and roughly what are your medical expenses to date?:
Were there any witnesses at the scene?:
At the time of injury, were you in the course of employment? If so, name & address of employer:

If you have missed work, please list the dates off:
If Work Related:
When was the last date you were paid work comp weekly benefits for this injury?:
What was the last amount of the weekly benefit payment?:
Employer's work comp insurance company:
Name of work comp adjuster & Claim#:
State the doctors, hospitals, chiropractors, psychologists & physical therapist(s) that you have seen for this injury:

If you have health or disability insurance, who is it with?:
Have you ever collected worker's compensation before?:
Who have you worked for in the past (who, when, and how long)?:

How far did you go in school (where attended) and if a diploma or GED received, what year:
If pursuing Social Security / Long Term Disability benefits:
Are you currently working? If no what date did you last work & why did that work end?:

If you have a physical or mental impairment, please describe:

Please indicate if you have applied for:
Social Security Benefits	Long Term Disability Benefits
Has your long-term disability carrier threatened to cut off benefits?:
When was the last denial or decision made?:
If you are pursuing long-term disability benefits, please state the name and address of the insurer:

Evlerson, Vasey & Peterson LLP
700 2nd Avenue
Des Moines, IA 50309

Map and Directions
Telephone: 515-243-1914 | Toll Free: 877-243-1914

The use of the Internet for communications with the firm will not establish an attorney-client relationship and messages containing confidential or time-sensitive information should not be sent.

Greg Peterson, Attorney at Law, represents clients in Des Moines, Iowa, including the city of Ames; and Polk County, Boone County, Story County, Marshall County, Jasper County, Marion County, Warren County, Madison County and Dallas County.