Request a Call

Request a Call from a Lawyer If you would like to receive a call from one of our Legal Panel Solicitors please complete the form below.

Your form will be automatically sent to our Legal Panel Coordinator who will make all of the necessary arrangements for you and pass on your details to one of our solicitors, who will be in touch with you directly as soon as possible.

You should receive a call back from a Legal Panel Solicitor within 24 hours of your initial request.

If you would like to speak to our Legal Panel Coordinator now please call 020 7650 1305 or email legalpanel@limbless-association.org

Please Note: As part of our agreement with the Panel, its members make an annual donation to the Limbless Association, which helps to ensure a good quality service. This financial agreement complies with the Solicitors Code of Conduct 2007.

Request a Legal Panel Call

Please enter today's date *

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Your Personal Details

Title *

First Name *

Surname *

Address line 1 *

Address line 2

Address line 3

Town *

County

Postcode *

Telephone number *
please provide the best contact number for our solicitor to call

Best time to call *

Email address

Date of birth *

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What's your current LA membership status? *

Details of Limb-Loss

Have you already had your amputation *
If "No" you can skip to the "Details of the Incident" section

Yes
No

Reason for limb-loss

Type of surgery / limb-loss

Date of limb-loss

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Which Limb Centre do you attend?

If other, please state

Details of the Incident

Where did the accident occur? *
town, country and location

When did the accident / incident occur? *

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Please give brief details about the incident / accident *

* Denotes required field.