Practice Areas
Ephedra
Fen-Phen
Guidant/Medtronic
Hip/Knee
Investor Loss
Medical Malpractice
Mifeprex (RU-486)
Nursing Home
Ortho Evra
Personal Injury
PPA
Prempro
Product Liablity
Vioxx
Walmart Gender Bias
Zevalin
home
firm overview
our lawyers
practice areas
verdicts & settlements
press
resources
contact us
Please Enter Your Email Address
Free Case Evaluation
Personal Injury
**
Required Field
First Name
**
Last Name
**
E-mail Address
**
Verify E-mail Address
**
Phone Number
**
-
-
Address 1
**
Address 2
City
**
State
**
Zip Code
**
Best Time to Call
**
Age
**
mm/dd/yy
Martial Status
Select One
Married
Single
Divorced
How did you hear about Lopez, Hodes, Millman & Skiko?
Please Select One
Advertising
Internet
Family
Friend
Other
Date of the incident
What is the cause of the injury?
prescription
environment
food
other
Have you seen a physician?
Select One
Yes
No
Are you on medication?
Select One
Yes
No
Is you condition worsening?
Select One
Yes
No
Specifically, what product caused your problem?
Did you have health insurance?
Select One
Yes
No
Damages
Incidental Costs:
Medical Expenses to Date:
Loss of earnings to date:
Comments:
IRVINE
9210 Irvine Center Drive
Irvine, California 92618
SAN FRANCISCO
625 Market St.
11th Floor
San Francisco, CA 94105
