A Settlement That Matters | Buxbaum Daue PLLC (406) 327-8677

Please fill out the form below to provide us with the basic information about you and your situation.

Our Team will review, then reach out to you within 24 hours to discuss how Buxbaum Daue PLLC can help make you whole.

*Indicates required field

Your Name(Required)

Patient Name(Required)

Address

Street Address City State ZIP Code

Phone

Email(Required)

Date of Birth(Required)

Date of Incident(Required)

Where did the injury/medical treatment occur?(Required)

City State / Province / Region

Provide the names of the Healthcare Provider(s) or facilities involved in your care:(Required)

Description of the event, your injury, and your concerns:(Required)

Were your medical bills paid by health insurance?(Required)

Yes

If so, please state the name of the company.

Did someone refer you to our office?(Required)

Yes

If so, who can we thank?

CAPTCHA

This field is for validation purposes and should be left unchanged.

Missoula Office:
3301 Great Northern Ave. Suite 201
Missoula, MT 59808

Telephone:
(406) 327-8677

Toll Free
1-888-771-8677

Fax
(406) 829-9840

Cookie	Duration	Description
cookielawinfo-checkbox-analytics	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checkbox-functional	11 months	The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy	11 months	The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.