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If you or a loved one has been seriously injured in a car accident in California, you will need a lawyer to help you recover damages for your medical bills and compensation for your pain and suffering. Please fill out all of the information requested below and we will refer your case to an attorney experienced in handling auto claims anywhere in California. You can also read more about CA accident laws.

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Title:

First Name:

  M. I.

 

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 If this inquiry is not for yourself, please tell us the name of the person?:

 Title:

 

First Name:

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What is the Injured's relationship to you?:

Injured's Date of Birth?
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Have you or they been been in an auto accident?:

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Date of accident?
(ie . mm/dd/19yy)

 What city and state did the accident occur in?

  What were your Injuries?

What type of medical treatment was received?

Who was responsible for the accident? 

Was the person(s) injured wearing a seat belt? 

Did the Police respond to the accident? 

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Did anyone recieve a ticket?

Yes No

Did the other driver have insurance?

Yes No

 Do you have insurance?

Yes No

 Do your currently have an attorney?

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Describe your injuries and Accident.

 
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