Dog Bite Free Case Review

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Contact Information
First Name*
Last Name
Home Phone*	- -
Work Phone*	- -
Cell Phone*	- -
Email Address*
Retype Email Address*
Street Address:
City
State/Zip

Injured Person's Contact Information
The injured person is
First Name:
Last Name:
Home Phone:	- -
Work Phone:	- -
Cell Phone:	- -
Email Address:
Street Address:
City:
State/Zip
Date of Birth
Sex	Male Female

Case Information
Were you or a loved one bit or attacked by a dog?
Yes No
Please describe the bite incident or attack

Was the owner of the dog present?
Yes No
Do you know who the owner of the dog is?
Yes No
If yes, what is his or her name?

When you or loved one was bit or attacked, were you in a public place?
Yes No
If yes, describe the location of bite or attack

If no, were you on private property?
Yes No
If yes, were you legally on private property?
Yes No
Were you or the loved one harmed in the bite incident or attack?
Yes No
Please describe the injuries

Was medical attention needed for the bite or attack?
Yes No
Did you or loved one get transported to the hospital?
Yes No
If yes, was transportation by an ambulance?
Yes No
Additional comments

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	b. I agree that submitting this form and the information contained within does not establish an attorney client relationship..
	b. I agree that my information will be reviewed by more than one attorney and/or law firm.
	d. I agree that the information that I will receive in response to the above question is general information and I will not be charged for the response to this e-mail question. I further understand that the law for each state may vary, and therefore, I will not rely upon this information as legal advice. Since this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter.

Regional California Dog Bite Info:

Learn more about California Dog Bite Law: