Alers Law

Accident Information

Date and time of accident | Día y Hora del Accidente

Did the police show up after the accident? | ¿Llegó la policía después del accidente?

Yes | Si

No

Name of police department | Nombre del Departamento de Policía

Police Report #, if Available | Número de Reporte Policial, si lo tiene

Did you go to the hospital/urgent care? | ¿Fuiste al hospital o sala de urgencias?

Yes | Si

No

If yes, did you get transported by ambulance? | ¿Te transportaron en ambulacia?

Yes | Si

No

Provide a short summary of how the accident happened. | Provea un resumen de cómo sucedió el accidente.

Describe you injuries. | Describa sus lesiones.

Do you have car insurance? |¿Tiene póliza de seguro para su auto?

Yes | Si

No

Were photos taken of you or scene? | ¿Se tomaron fotos de la escena o lesiones?

Yes | Si

No

Contact Information

First Name | Nombre *

Last Name | Apellidos *

Email *

Phone |Teléfono *

Address *

City | Cuidad *

State | Estado *

Zip Code | Código Postal *

How did you find us?

How did you hear about our firm? | ¿Cómo escuchó de nosotros?

Texas Bar Website

Denton Bar Website

An attorney referral | Un abogado

NOSSCR - National Association of Social Security Disability Representatives

NADR - National Association of Disability Representatives

Texas Referal Line Service

Referred by Doctor | Un Doctor

A profesional | Un Profesional (Nurse, Social Worker, CPA, Financial Advisor, Chiropractor or other)

Social Media (Facebook, Instagram etc.)

Google

Workshop (Taller o Conferencia)

Other | Otra

Name of the Person or Agency who referred you | Nombre de la persona o empresa que le refirió a nosotros

Comments or additional information | Comentarios o información adicional

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