Contact Our NC Workers Compensation Lawyers, Workplace Injury Attorneys: Winston Salem, North Carolina

Elliot Pishko Morgan P.A.
426 Old Salem Road
Winston-Salem, North Carolina 27101
(Forsyth County)

Phone: 336.724.2828
Fax: 336.724.3335
Email: info@NC-WorkersCompensation.com

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Name:
Street Address:
City:
State:
Zip Code:
E-mail:
Phone Numbers:
Name of Employer:
Where Injury Happened:
Date of Injury:
Type of Injury:	e.g. hurt lifting, fell, hand caught in machine, breathing chemicals, etc
Details of Injury:	please include as much relevant information as possible, e.g. I needed surgery for ______, describe other medical treatment and expenses, I missed __ months of work, I am able (or not able) to return to my old job, etc.
Are wage loss and medical benefits currently being paid?	Yes No Explain
When to call & further contact information:
How did you hear about us?

Please know that you are not considered a client of this firm until your case has been accepted by us and you have signed a formal retainer agreement.

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