SUBMIT A BILL Name * First Name Last Name Email * Did you receive a medical bill after being treated by a doctor, urgent care or hospital? * Yes No What is the name of your medical provider? * What is the amount of the medical bill you're contacting me about? * $ Have you spoken to a lawyer about the injury or illness that required your medical care? * Yes No Do you have health insurance? * Yes No Please describe the injury or illness that required you to seek medical care. How did you hear about Walrath Law? * Referral from an Injury Attorney Referral from Friend/Family Radio or TV Social Media Direct Email or Mail Advertisement Thank you!
