Personal Injury Forms

  1. Medical Release HIPAA
    I will need this form initialed and signed, so please download the document, initial the four small lines with the “x”s, sign where it says “signature,” and that’s ALL you need to do; don’t date it or fill in anything else.  Then you can either scan and email the document, fax it, or mail the original.   Call me with any questions.

2. Personal Injury Intake Form

3. Personal Injury Representation Agreement

Contact Jeffrey

Jeffrey Allen Howard, Attorney at Law, PLLC
1829 E. Franklin St. - Bldg 600
Chapel Hill, NC 27514

(P) 919-929-2992
(F) 919-636-4779

Address Doesn't Matter!