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ASSESSMENT Q/A FORM

INVOLVED IN A PERSONAL INJURY? NO WIN – NO FEE

You maybe entitled to paid medical treatment & maximum compensation

 

GET THE HELP YOU NEED BY COMPLETING THE QUESTIONNAIRE

How were you hurt? Please complete all the question for best results

Car AccidentMotorcycle AccidentBus AccidentBicycle AccidentTruck AccidentUber/Lyft AccidentPedestrian AccidentWrongful DeathOther Injury or Accident

Briefly describe your accident

Did you have to go to the doctor?

YesNo

What is your phone number?

### - ### - ####

What is your Full name?

First Name

Last Name


Email

When did the accident or injury occur?

In the last 30 days2019 (outside 30 days)2018201720162016 or Before

We’ll call you within 24 hours to see if you qualify

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Involved in a personal injury?

Complete the Q & A Form below. You maybe entitled to paid medical treatment & maximum compensation.

Recover what you deserve
fast & easy  NO WIN – NO FEE

Over $ 815.000

Car v. truck accident

Experience practicing

In Los Angeles last 20 years

Reliable & exceptional

Service & results

This site displays some of the representative cases Joshua Haffner handled at Haffner Law PC or his prior law firms – Copyright © 2019 Haffner Law