Reza Athari & Associates, Pllc
Licensed in Nevada


3365 Pepper Lane, Suite 102
Las Vegas, NV 89120
Tel: 702-727-7777
Fax: 702-458-8508

ACCIDENT INTAKE

BACK TO HOMEPAGE

This information is Strictly Confidential

PERSONAL INFORMATION:

Name (Concerned Person):

E-mail Address:

Home Address :

Type of Work:

Home Telephone No.:

Work No.:

Date of Birth:

ABOUT THE ACCIDENT:

Date of Accident:

Where did accident take place? (Intersection)

Is this your first accident with injury?

If no, list all prior accidents/injuries.

List your injuries:

Were you transported by ambulance to the hospital?

If yes, what hospital?

Were the police called?

Do you have an accident report?

Who do the police say was at fault?

Do you have insurance?

Name of Insurance Company:

Did other driver have insurance?

Name of Ins. Company:



Free consultation is limited to 10 minutes to evaluate your case - NO FREE LEGAL ADVISE.
****This Law Firm has invested significant financial and marketing resources in developing the practice. The firm does not prevent a client from posting commentary about the Firm-its practice or expertise on web page or blogs. In consideration for services and noted protection, if the client prepares such commentary for publication on web page about the Firm, the client assigns all intellectual Property rights , including copyrights , to the Firm for any written, pictorial and/or electronic response .The client acknowledges the effectiveness at the time execution of this intake and commentary.****

Las Vegas, Nevada:
Reza Athari & Associates

3365 Pepper Lane, Suite 102
Las Vegas, NV 89120
Tel: (702) 727-7777
Fax: (702) 458-8508
Web: www.atharilaw.com

Salt Lake City, Utah:
Immigration Law Offices of Reza Athari, PLLC

525 W 5300 S # 175
Murray,UT 84123
Tel: (801) 537-7777 
Fax: (801) 363-0506

Web: www.slcimmigrationattorneys.com

San Diego, California:
Reza Athari & Associates

3444 Camino Del Rio North Suite # 103
San Diego, California 92108
Tell: (619) 284-8811
Fax: (619) 284-8822
Web: www.rezaathari.com


St. George, Utah:
Immigration Law Offices of Reza Athari

1036 E. Red Hills Parkway, Suite D
St. George, UT 84770
Tel: (435) 656-1136
Fax: (435) 656-1145
Web: www.stgimmigrationattorneys.com

Downtown Las Vegas location:
Reza Athari & Associates, Pllc

626 S 9th st Las Vegas Nevada 89101
Las Vegas, NV 89101
Tel: (702) 727-7777
Fax: (702) 458-8508
Web: www.atharilaw.com

Mexico:
Reza Athari & Associates


Skype: Visasyperdones
Email: consulta@visasyperdones.com

Web: www.visasyperdones.com








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