Name / Nombre *

Email / Correo Electrónico *

Phone Number / Número Telefónico *

Language / Idioma *

Language Preference

English
Spanish
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Date of Incident / Fecha del Incidente *

Were you injured? / ¿Saliste lesionado del incidente? *

Were you injured?

Yes
No
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Is someone else at fault for the incident? / ¿Alguien más tuvo la culpa por el incidente? *

Is someone else at fault for the incident?

Yes
No
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Do they have valid insurance? / ¿Tienen Seguro válido? *

Do they have valid insurance?

Yes
No
I'm not sure
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Do you have insurance coverage? / ¿Tienes Covertura de Seguro? *

Do you have insurance coverage?

Yes
No
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Have you accepted any type settlement for your injuries? / ¿Has aceptado algún tipo de oferta por tus lesiones? *

Have you accepted any type settlement for your injuries?

Yes
No
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Case Details / Detalles de tu Caso *

Nearest Location / Ubicacón más cercana

Please Select an Office / Por favor seleccione una oficina

Kennewick
Yakima
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In case of selecting Immigration, please proceed to select the office location closest to you and submit this form to schedule your initial consultation.

En caso de seleccionar Inmigración, por favor selecciona la loficina mas cercana a ti y completa este form para agendar tu consulta inicial.

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