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Law Offices of
Fabian C. Serrato
 3701 West McFadden  Ave.
Suite L
Santa Ana, CA 92704
Phone: 714.775.6654
Fax: 714.775-6655

Toll Free: 888.703.6577
 click here to email

 

CAR ACCIDENT FORM
 

 
 

E-Mail:
First Name:
Last Name:
Address:
City:
State: CA   Zip:
Home Phone:
Work Phone:
Contact by:

Age:
Sex:
Date of Accident:  Month Day Year
Police Report:
Witness:
Your fault?
You have insurance?
Other driver have insurance?
How did the accident happened:
 
Visible damage to vehicle?
Visible damage to other vehicle?
Were you injured?
Were you driver or passenger?
Have you seen a doctor?
If yes when: Month Day Year
   

Thank you. Remember, all your information is strictly confidential.
 You will be contacted promptly.

   

 
   


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