Estey & Bomberger, LLP - Brain Injury Lawyer

Case Submission Form - free consultation

For a free, no-obligation consultation with an experienced attorney regarding cases of personal injury and brain injury, please submit the following response form. We will respect the confidentiality of your information to the fullest extent. Form submissions are relayed to us through our highly secure servers.

If you prefer, you may contact us at 800-672-1036.

Tell us who you are and how we can contact you. Note: This information is strictly confidential and will not be communicated with anyone. It is necessary only for purposes of enabling us to do a conflict of interest check prior to responding to you. We cannot respond without being able to do our conflict check.

First Name

Last Name

Number, Street & Apt.

City

State

Zip

Email

Day Phone

Night Phone

Please provide a brief personal background of the person needing assistance. Many times we are contacted by someone other than the person in need of help, such as a parent on behalf of a child, or wife on behalf of a husband. Please provide the following information on behalf of the person who needs assistance.

The following information is for myself: Yes No

If "No" my relationship to the following person is:

First Name

Last Name

Age

Occupation

For how long

Current or last employed

City and State where last employed

Highest grade completed

Schools/College attended

Degrees

Year degree granted

Special training or experience in

Why Do You Need Help? Please provide us with a very brief overview, in 200 words or less, describing in general the subject matter of your request. You can provide more detailed information below, but for now please confine yourself to providing us with a brief statement of the general facts of your case, injury and damages.

State the date you were injured or when you first learned that you had been injured?

What occurred?

Where did it happen? Please type in the City, County and State where it happened:
City
State
County

Who caused the harm? Please type in the names & addresses of all the wrongdoers involved:

What damages were suffered? Describe the damage you have suffered:

Has anyone already filed a suit? Yes No

When is the best time to reach you by telephone?

When the information you have provided is complete, please press the Submit button below to send it to Estey & Bomberger, LLP. Your information will be kept strictly confidential.

The brain injury information offered by Estey & Bomberger, LLP and contained herein, regarding Los Angeles brain injury statutes and Los Angeles brain injury claimants' rights is general in scope. No attorney client relationship with our Los Angeles brain injury attorneys is hereby formed nor is the brain injury information herein intended as formal legal advice. Please contact a Los Angeles personal brain injury lawyer regarding your specific inquiry. See Terms of Use.

The attorneys at Estey & Bomberger, LLP are available for home and hospital visits and can be reached by telephone 24/7 at 800-672-1036 or contact via E-Mail at info@estey-bomberger.com.

Name:

Email Address:

Phone:

Where did the Brain Injury Occur?

When did the Brain Injury Occur?

What Happend?

Your Injuries:

Who Was At Fault?