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Free Case Evaluation

Please take a moment to complete this form. Please provide as much information as possible when submitting the evaluation form. Should you require immediate assistance please call our office at (916) 329-9010.

When you have completed the form please click the "submit" button and an attorney will contact you to discuss your case as soon as we have reviewed your information. All information is kept strictly confidential and is used only by the Law Offices of Alan M. Laskin for informational purposes.

 YOUR CONTACT INFORMATION
    Your Name:
    Address:
    City:
    State:
    Zip Code: 
    Home Telephone: - -
    Email Address:
 YOUR INJURY INFORMATION
    Injury Type:
    Where did injury occur?
    Date & time of injury:
    Other party's insurance:
    How did the injury accur?
    Who was at fault & why?
    List prior injuries:
    Description of Incident:

**PLEASE DO NOT GIVE A WRITTEN OR RECORDED STATEMENT TO THE INSURANCE COMPANY!**



For A Free Consultation Call:
(916) 329-9010

Email Us:  info@laskinlaw.com



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