Attorney Robert Brenner - pain and suffering settlement

Super Lawyers - Recipient of the Sothern California Super Lawyers Award 2006

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Injured Party Contact Information

The Law Offices of Robert A. Brenner offer civil litigation services in the field of Personal Injury. The law offices consistently provide high quality, aggressive legal representation in the increasingly complex area.

If you have any questions regarding your legal rights please fill out the form below. We will do our best to respond to your inquiry with in 24 hours and carefully explain your legal rights to you.

First Name:

Last Name:

Street Address:

Suite:

City:

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Zip Code:

Home Phone:

Work Phone:

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Fax:

Email:

Family Member Contact Information:
If you are contacting us on behalf of the injured party, please provide your Name, Address, and Phone Number:

Are you currently represented by counsel?
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Would you like to learn more about your legal rights?
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Please provide the following injury information in the area below:

Date and Location of the Injury?

Burn Survivor's date of birth and occupation?

Where and how the injury occurred?

Witnesses to the injury?

Any unsafe conditions that may have caused the injury?

When were you (or the party of concern) injured?

Please select the type of burns you suffered:

What percentage of your body was burned in the accident?

If your injuries occurred at work please provide:

The name of the company you work for

A description of your job

A description of the site where your injury occurred

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	20750 Ventura Blvd., Suite 201 Woodland Hills, CA 91364	(P): 800-669-7700 (F): 818-999-9745
If you have questions concerning your legal rights, please contact us. Copyright © 2001, 2002 The Law Offices of Robert A. Brenner. All rights reserved.