More Ways to Contact Us
For immediate assistance seven days a week, call
For general inquiries, e-mail
or use our main
Free Consultation for Personal Injury
Use this simple form to provide us with information that will help us prepare for your
. The information you are providing via this form shall be treated confidentially and is protected under the Attorney-Client privilege. Once received, we will phone you back at our earliest convenience. Please note that this form is for
personal injury cases only
. Use these links for other types of cases:
Criminal or Federal Case
Civil Defense Case
Juvenile Delinquency Case
Juvenile Dependency Case
indicates a required field.
Date of Birth
City, state, zip
(At least one phone number is required.
Use the format
Briefly explain how the accident happened.
Do you have auto insurance?
Please provide the name of your insurance company and your policy or claim number.
Describe your injuries.
Which doctors have you seen?
Information about the other driver (name, address, driver's license,
Was a police report written for the accident?
If yes, please provide the following information.
Police Report Number
Date of the Accident
Location of the Accident
Describe the damage to your vehicle and the damage to the other vehicle. Amount or estimates of damage costs?
Please tell us how you found our web site.
West / Findlaw Legal Directory (Lawoffice.com)
Martindale-Hubble Legal Directory (Lawyers.com)
Verizon Superpages Directory (SuperPages.com)
SBC Smartpages Directory (Smartpages.com)
Google Search Engine (Google.com)
AOL Search (AOL.com)
Yahoo! Search (Yahoo.com)
Other (please indicate):
Perez & Perez respects your privacy and does not sell or share your confidential information with any other parties. Read more about our privacy practices in our
The information provided at this web site by Perez & Perez, including all emails and newsletters, is not intended to be legal advice, and legal representation is subject to additional terms and conditions of a signed contract. To read more about this, please see our
1440 N. Harbor Blvd., Ste. 900, Fullerton, CA 92835, Phone: (714) 961-1966, Fax: (714) 961-1972
Copyright © 2001-2017, Perez & Perez. All rights reserved.