Military Bases Claim Application Form

Myself On behalf of a family member

First Name

Last Name

Phone Number

Email

Address

City

State

Zip

Date of birth

Date of death (if completed for a decedent)

Have you been diagnosed with one of the following injuries?

Approximately when were you diagnosed?

Are/were you in the U.S. Military?

Are/were you stationed on one of the following bases?

How long did you live on base?

Message

Social Media:

Main Office:

2160 Highland Ave,
Birmingham, AL 35205

Get Directions

205.328.9200

Washington DC Office:

2101 L St NW, Suite 800,
Washington, DC 20037

Get Directions

202.903.0727

Business Hours:

Monday – Friday
8:00 AM – 5:00 PM

Saturday & Sunday
Closed

No representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers. This web site is designed for general information only. The information presented at this site should not be construed to be formal legal advice nor the formation of a lawyer/client relationship.