Colin Patino & Company Lawyers

Telephone:	1800 006 236
Fax:	07 3805 7099
Address:	Meadowbrook Office: Unit 1, Meadowbrook Shopping Village Loganlea Rd Meadowbrook, QLD, 4131 Australia Oxley Office: 130 Oxley Station Rd, Oxley, QLD, 4075 Australia
Postal Address:	PO Box 5333, Daisy Hill, Qld 4127
Electronic Mail:	General Information: info@colinpatino.com.au


Claim Assessment
		* = Required
Name:		*
Firm/Company:
Street Address:
City, State, P/C:
Day Phone:		*
Evening Phone:
Mobile:
Fax:
Email:		*
		Multiple items may be chosen:
Motor accident:
Work related injury:
Slip and fall:
Public Liability:
Product Liability:
Case Description:
Comments/Questions:
		Multiple items may be chosen:
Contact you by day phone:
Contact you by evening phone:
Contact you by mobile phone:
Respond by e-mail:
Respond by fax:
Set up office appointment:

Thank you for providing the above information. It will be treated as confidential correspondence. If you have asked for a response, we will get back to you as soon as possible. If you need an IMMEDIATE response, please call us on 07 3805 7088.