THE LAW OFFICES OF RICHARD S. PADDOR
                                8500 Wilshire Blvd., Suite 924 / Beverly Hills, CA  90211
                                     800-789-8088 / 310-289-8088 / Fax:  310-289-8184
                                                           
                                                         CASE EVALUATION FORM
 Your completion of the evaluation form concerning a potential case you may have is very important to us.  We are very sensitive to your needs.  We commit to you  that we will promptly respond even if we cannot help you. 

Our review of the completed case evaluation form does not constitute an attorney-client relationship.  Mr. Paddor's review of the case evaluation form does not mean he is representing you.  For Mr. Paddor to be hired as your lawyer, a written retainer agreement must be signed by you and him.

 
Personal Injury Case Evaluation Form
 800-789-8088

Email:  richard@paddorlaw.com

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Please submit this form for a FREE evaluation and consultation.  Please provide as much information
as possible.  You will receive a response shortly.  All information received will be kept strictly confidential.

What kind of legal matter do you have?

Accident Worker's Compensation Insurance Bad Faith
Wrongful Termination Other

Name
Street
Address
City
State
Zip Code
Home Phone
Work Phone
Fax
Email

Please provide the following information:
    
Date of Birth:      

Date of Accident:

If Worker's Compensation, Name of Employer:

                           

        Job Title:    

          Place of Accident:

           Description of accident:

          

            Description of injuries:

           

            For auto accidents, any passengers?
                

             Names and phone numbers of all passengers:
              
             
             
             Name, address and telephone number of responsible party?

            
            

             Why do you believe that the party is at fault?

            
            
                    
             Identify the responsible party's insurance company?

            

              Did you have auto insurance on the date of the accident?
              
              

Please contact me as soon as possible regarding this matter.

Richard S. Paddor
Copyright © 2002 The Law Offices of Richard S. Paddor. All rights reserved.
Revised: February 02, 2005 .