SUBMIT A FREE CASE REVIEW


Please fill out the following for a free case review. The information submitted will be accorded the utmost confidentiality. This information is necessary in order to do a conflict of interest check before responding to you. If you prefer, you may contact us at our toll free number, (800) 300-0001.

Please provide the following information for the person in need of assistance.
Full Name

Date of Birth

Street Address

City, State, Zip

E-Mail

Home Phone

Other Phone

Marital Status
Married
Single
Separated
Divorced
Widowed

 

Name of Spouse, If Any

Occupation

Highest Level of Education Attained
High School
Some College
4 Year Degree
Advanced Degree

 

Please provide a brief overview of the legal matter you need assistance with.

 

Injury Cases

If you need assistance with an injury matter (including wrongful death claims, product liability claims and malpractice claims) please submit the following information as well.
City and State in which you were injured.

Name(s) of the person(s) who you allege caused you injury, and their addresses, if known.

Please describe your injuries.

Please describe any treatment you have had so far.

Are you still being treated for your injuries?
Yes
No

 

If yes, what kind of treatment are you now getting and/or do you anticipate in the future?

What is the approximate amount of your medical bills thus far?

Have you been forced to miss work due to your injuries?
Yes
No

 

If so, how much in lost wages and/or benefits have you sustained?

Have you been contacted by any insurance company regarding your injuries?
Yes
No

 

If so, what is the name and address of the insurance company and adjuster(s) you have talked to?

Are you currently represented by another lawyer?
Yes
No

 

If so, please give us the attorney’s name, address and phone number.

 

If you Are Not The Injured Party

If you have filled this information out for someone else, and are not the person in need of assistance, please answer the following:
Full Name

Street Address

City, State, Zip

E-Mail

Home Phone

Please describe your relationship to the person in need of assistance (e.g. parent, spouse, friend)

For Parents or Guardians

If the person in need of assistance is not a minor or disabled, we will need to communicate directly with that person regarding our review, in order to maintain attorney/client confidentiality. If the person in need of assistance is a minor or is a disabled adult with an appointed guardian we will need to communicate with that parent or guardian. With this in mind:
Who is the person to be contacted after we have completed our review?

What is the best time to contact that person?

What is the best way to contact that person? (e.g., e-mail, phone, letter)

 

After the information is complete, please press the submit button. We will review the information and contact you as soon as we have done a conflict of interest check.


Web Site Disclaimer: The California personal injury, criminal, medical malpractice, nursing home abuse, product liability, mass tort drug litigation, consumer fraud, business litigation, and/or other legal information offered herein by California Personal Injury Attorneys is not formal legal advice nor the formation of an attorney client relationship. Our California law firm handles law suits in the areas of and around sate including Los Angeles, Orange County, San Diego, Long Beach, San Francisco, San Jose, Sacramento, Riverside, San Bernardino. We handle cases statewide.

The determination of the need for legal services and the choice of a lawyer are extremely important decisions and should not be based solely upon advertisements or self-proclaimed expertise. Memberships and offices in legal fraternities and legal societies, technical and professional licenses, and memberships in scientific, technical and professional associations and societies of law or field of practice do not mean that a lawyer is a specialist or expert in a field of law nor do they mean that such a lawyer is necessarily any more expert or competent than any other lawyer. All potential clients are urged to make their own independent investigation and evaluation of any lawyer being considered.