Name: Andrews, Bernstein & Maranto, PLLC
Address: 420 Franklin St, Buffalo, NY, 14202, US

Date of Incident

Were you physically injured or in pain?

Yes

No

Was the accident your fault, or were you issued a ticket for the accident?

Yes

No

Does anyone involved have vehicle insurance coverage?

Yes

No

What types of injuries were sustained? (please check all that apply)

Muscle Strain

Lost Limb

Brain Injury

Broken Bones

Spinal Cord Injury or Paralysis

(716) 995-4674

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