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How long ago was your accident? *

7 Days or Less

30 Days or Less

Within 3 Months

Less than 1 Year

Within 2 Years

Over 2 Years Ago

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IP Address

Please select the severity of your accident *

Mild Injury (ex. Soreness, aches, pains)

Minor Injury (ex. Cuts, scrapes, and bruises)

Moderate Injury (ex. Broken bones, dislocations)

Severe Injury (ex. Extensive medical treatment or surgery)

Catastrophic Injury (ex. Lasting harm, long-term impairment)

Wrongful Death

Did you receive medical attention after your accident? (Ambulance, Hospital, ER, Chiropractor, Doctor, ETC.) *

Yes

No

Was the accident your fault? *

No, it was not my fault

I was a passenger

Yes, I was at fault.

Have you accepted a settlement for injuries sustained in your accident? *

No

Yes

Are you currently working with an attorney? *

No

Yes, but I’d like a new one

Yes

Please enter your contact information

Full Name *

Phone Number *

Email *

By clicking Submit, you affirm you have read and agree to the Terms and you agree Tofer & Associates and its employees may use automated technology to deliver marketing calls, texts, or emails to the number or email you provided regarding your project. You also agree Tofer & Associates may use automated technology to deliver marketing calls, texts, or emails to you regarding offers. Consent is not a condition of purchase.

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Beverly Hills, CA

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