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Intake Form

The Law Offices of Paul W. Cutrone, concentrates on the prosecution of personal injury, wrongful death and medical malpractice law suits for the victims of negligence in Queens and communities throughout the New York City metro region. Attorney Paul Cutrone is a litigation attorney with 25 years of experience. He has been admitted to practice in the N.Y.S. Courts since 1982. Contact our offices in Glendale or Garden City, New York, to schedule a free consultation about your specific personal injury or medical malpractice injury or wrongful death claim today.

NOTE: An asterisk (*) indicates REQUIRED information. The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

*Your Name:   
*Your Email Address:   
Your Telephone Number:   
 
How would you like to be contacted?
 Email
 Phone
      
 
Name of injured person:   
Your relationship to the injured person:   
Injured persons county of residence:   
Injured persons date of birth:   
Injured persons occupation:   
Date of injury:   
Where did the incident or injury occur?   
Please describe the incident or failures to act appropriately that you believe caused the injury:

What injuries were caused by the negligent actions?

Has the injured party lost time from work because of the injuries, and if so, how much time?

Have you consulted with any other law firm with respect to this matter?