Personal Injury Lawyer

Personal Injury Lawyer

Vechicle Accidents

Wrongful Death

Brain & Spinal Injuries

Burn Injuries

Slip & Fall

Prouct Liability

Serious Injuries

Dog Bites

Motorcycle Accidents

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Contact Personal Injury Law Offices of Burg And Brock

Toll Free: (888) 979-7979            Fax: (818) 981-0344

E-mail: cameron@burg-brock.com

Sherman Oaks Personal Injury Law Office:

Address: 15260 Ventura Blvd. Suite 820 Sherman Oaks, CA 91403
Tel: (818) 981-9114

Glendale Personal Injury Law Office:

Tel: (818) 999-9999

Beverly Hills Personal Injury Law Office:

Address: 8900 Wilshire Blvd. Suite 320, Beverly Hills, CA 90211
Tel: (310) 285-9777

Irvine Personal Injury Law Office:

Address: 8001 Irvine Center Drive Irvine, CA 92618
Tel: (714) 550-7777

Contact Us

Name:*
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Matter Information

   
Were you injured?
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Were other people injured?
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Did a relative die?
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If a relative died, state how you were related.
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What is the nature or extent of your injuries? Are the injuries permanent?
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Where did the accident or injuries occur?
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How did the accident or injuries occur?
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Do you have the name and address of the person who caused the accident?
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State the names and addresses of the person or persons who caused the accident.
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How much are the medical bills?
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How much is the loss of earnings to date?
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Does the other party (wrongdoer) have liability insurance?
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If you were in an automobile or motorcycle accident and you were the driver, did you have liability insurance?
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Do you have medical insurance?
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If this was an automobile or motorcycle accident, was there a police report?
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Were there any witnesses?
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State the names and addresses of the witnesses.
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Have you filed a lawsuit?
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Telephone number and a convenient time to call you.
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Please indicate any other facts that you believe are important.
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Please do not include any confidential or sensitive information in this form. This form sends information by non-encrypted e-mail which is not secure. Submitting this form does not create an attorney-client relationship.
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Personal Injury Lawyer