Wrongful Death Questionnaire

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Your Name (required)

Your Email (required)


Your Relationship to Deceased

Age of Deceased

Date of Death

Date of Accident

Location of Accident

Describe the Accident

Describe the Injuries and Treatment Before Death


Please click the Submit button. If you do not receive a confirmation message, an error has occurred. Therefore, kindly confirm the required fields (including Name and Email) and verify your answer to the security question. Then please submit this form again. If you are unable to successfully submit this form, please call us.

Notice: Your submission of this form, or a free telephone consultation, will not constitute an attorney-client relationship.

About Us

Michael W. Goldstein, Esq. has been practicing New York personal injury law, including accidental injuries causing death, since 1979. If a close relative of yours died as a result of an accident or medical malpractice, please complete and submit the form above, to see if we can help to obtain monetary compensation for your tragic loss.

New York Injury Attorney Disclaimer

The New York personal injury, accident, injury, serious accident, or other personal injury legal information contained in this website is not intended to constitute legal advice, nor to create an attorney-client relationship or lawyer-client relationship. We recommend that you discuss your accident case with a Personal Injury Attorney or Accident Lawyer practicing law in New York promptly, since there are strict time limitations that apply to New York injury lawsuits. This website is not intended to solicit clients for accident cases outside of New York State. Under New York law, in the event there is no recovery in a contingency fee case, the client is responsible for the expenses of the litigation, including court costs and disbursements.

New York Personal Injury Lawyers and Attorneys New York representing accident victims who have sustained serious injuries in New York City, Manhattan, Bronx, Brooklyn, Queens, Staten Island, Long Island, Nassau County, Suffolk County, Westchester County, Rockland County and upstate New York.

Law Offices of Michael W. Goldstein
Personal Injury
Wrongful Death

Telephone: (212) 571-6848
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