New Case Intake Form

Full Name*

First NameLast Name

Please only submit this form for one person at a time, and please fill out the form in the name of the person needing help.

For example, sometimes with auto wrecks multiple people will be injured together and want to hire the same attorney, please fill out the form twice.

Sometimes when someone has been arrested, they aren't available to fill out the intake form and a family member will fill it out, please put the name of the client.

What is your date of birth?

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone Number*

Here at Trauma Law California, we believe in easy communication with your legal team so we use a case texting service. By providing your cell phone number, we will enroll you in that case texting service which allows you to send text and picture messages straight to your file and those messages are routed to everyone on your legal team. No more waiting on hold, waiting for calls back, or explaining the same situation several times.

Is there an alternate phone number you'd like us to have on file for you?

Please enter a valid phone number.

Gender

MaleFemaleOther

E-mail*

example@example.com

What date did your incident occur on?*

Date

How did you hear about us?*

Please Specify*

What type of issue are you dealing with?*

Tell us about your incident:

You can set up a consultation appointment using the scheduling link below. This consultation will be an opportunity for you to speak with our attorney where you can explain this in more detail but we do like to get as much information as possible up front so that our attorney, Shanna Hesketh, can prepare for her discussion with you.

What county did the incident occur in?

Please upload any photos or documents that you have regarding your incident so that our attorney can review them to prepare for speaking with you.

Please be sure to take and upload photos of the following: any visible injuries, driver's license, insurance cards, bail documents, law enforcement incident cards, and any documents you've received regarding the incident.

Do you have any particular questions or concerns?

Feel free to type no if you can't think of any right now-- once you hit submit on this form you'll be enrolled in our case texting service and you can text us questions or concerns at any time!

Are you experiencing any symptoms from your injury related to your head?

Are you experiencing any symptoms from your injury related to your neck?

Are you experiencing any symptoms from your injury related to your back?

Are you experiencing any symptoms from your injury related to your LEFT shoulder?

Are you experiencing any symptoms from your injury related to your RIGHT shoulder?

Are you experiencing any symptoms from your injury related to your LEFT arm?

Are you experiencing any symptoms from your injury related to your RIGHT arm?

Are you experiencing any symptoms from your injury related to your LEFT elbow?

Are you experiencing any symptoms from your injury related to your RIGHT elbow?

Are you experiencing any symptoms from your injury related to your LEFT wrist?

Are you experiencing any symptoms from your injury related to your RIGHT wrist?

Are you experiencing any symptoms from your injury related to your LEFT hand?

Are you experiencing any symptoms from your injury related to your RIGHT hand?

Are you experiencing any symptoms from your injury related to your LEFT hip?

Are you experiencing any symptoms from your injury related to your RIGHT hip?

Are you experiencing any symptoms from your injury related to your LEFT leg?

Are you experiencing any symptoms from your injury related to your RIGHT leg?

Are you experiencing any symptoms from your injury related to your LEFT knee?

Are you experiencing any symptoms from your injury related to your RIGHT knee?

Are you experiencing any symptoms from your injury related to your LEFT ankle?

Are you experiencing any symptoms from your injury related to your RIGHT ankle?

Are you experiencing any symptoms from your injury related to your LEFT foot?

Are you experiencing any symptoms from your injury related to your RIGHT foot?

Are you experiencing any of these miscellaneous symptoms?

While submitting this form is the first step to becoming a client of Trauma Law California, it does not automatically make you a client. The attorney-client relationship is not created until you sign a retainer agreement and are accepted as a client of Trauma Law California. Trauma Law California will not be taking any steps on your behalf or doing any work on your case until that attorney-client relationship is created.

With that in mind, all communications between you and Trauma Law California (including this form) will still be private, privileged, and confidential as those statements are made for the purpose of seeking legal advice and representation.

By clicking "Submit" on this form, you are agreeing to those statements.

new case intake form: