Contact Info James S. Higgins Phone (615) 353-0930 Address Higgins, Himmelberg & Piliponis PLLC 116 Third Avenue South Nashville, TN 37201 E-mail jhiggins@hhpfirm.com
	Tell Us About Your Worker's Comp Claim All information will be considered confidential, but your completing and submitting this form in no way creates an attorney-client relationship. We shall contact you further to discuss your claim. First & Last Name Postal Address Phone Number Email Address Injury You Have Suffered Please Briefly Describe How Your Injury Occurred Approximate Date of Injury Additional Information By submitting this form, you agree that we may contact you to further discuss your case should we deem it appropriate. Your submission of this form does not form an attorney-client relationship.