Lawyer - Christopher Kerosky
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Pesonl Injury Questionnaire

  • Persons seeking legal representation with our law firm may wish to schedule a telephonic or in-person consultation with any of our attorneys. Call our receptionist at (415) 777-4445 to schedule a legal consultation with our attorney. Please call us during our regular business hours (9:00 am to 5:30 PM, Pacific Time). The cost of the consultation is $200 (U.S.) for 60 minutes.
  •  When you call to schedule your consultation, please be prepared to pay the fee by check, which must be received prior to the appointment.
  • On the day of your consultation please call the office at (415) 777-4445 at the time scheduled. Legal consultations are scheduled every 60 minutes from 10:00 AM to 4:00 PM, excluding lunch time (noon to 1:30 PM). If you call late, this will decrease the amount of time that you will be able to spend speaking with the attorney. If you must cancel or reschedule your consultation, you must do so at least 24 hours in advance in order to obtain a refund.
  • If you retain our law firm on the day of your consultation, we will be happy to credit the $200 consultation fee toward the overall cost of your case.
  
 Basic Information
  
  Last Name:
  First Name:
  Middle Name:
  Address:
  City:
  State:
  ZIP/Postal Code:
  Country
  E-mail Address:
  Home Phone:
  Work Phone:
  
  Date of injury
  
 Name and Address of Responsible Party:
  
  Last Name:
  First Name:
  E-mail address:
  Street address:
  City:
  State:
  Zip/Postal code:
  Country:
  Phone:
  
 Description of accident:
  
  Type of Accident:
  What happened:
  
  
  Damage to Vehicle
  (Yours and/or Theirs):
  
  Physical Injuries to you and others:
  
  
  Lost Wages?:
  Did you contact the police?:
  If so, which department?:
  Do you have a copy of the police report?:
  Were there any other reports done:
  
 Please include any other comments in the following field:
  
  
  
 Statement of Truthfulness

  "By pressing the Submit Questionnaire button below, I certify that all of the information contained in this form is true and correct to the best of my knowledge."
  Type in your name:
  Type in today's date: