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Goolsby Attorney At Law
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Richard Hays Goolsby Jr.
(706) 726-6798
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Georgia Civil Litigation Attorney

Please Fill Out This Form to the Best of Your Ability. Filling out this form does not create an Attorney-Client Relationship between you and I. However, all information submitted will be kept confidential.


Your Full Name:
Your Home Phone Number:
Your Cell Phone Number:
Your Other Phone Number:
Your Email Address:
Your Mailing Address:
Name of Other Party:
Type of Case:
What Happened:
Your State Of Residence:
Your County of Residence:
Type of Injury You Suffered:
State of Other Party:
County of Other Party:
Has Anything Been Filed: Yes No
Relationship to Other Party: Stranger Friend Family
When Injury Occured:
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Other Important Information:
Your Questions:

Filling out this form does not create an Attorney-Client Relationship between you and I. However, all information submitted will be kept confidential.


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