Free Injury Case Evaluation Form
Please take a moment to complete this form. Provide as much information as possible. This form is intended to assist us with a preliminary evaluation of your case. When you have completed the form please click the "Submit" button and we will contact you to discuss your case as soon as we have reviewed your information.
Note: fields with a * are required.
**PLEASE DO NOT GIVE A WRITTEN OR RECORDED STATEMENT
TO THE INSURANCE COMPANY!**
Stawicki & Maples
5207 Sunrise Blvd.
Fair Oaks, CA 95628
Tel: (916) 363-2889
Fax: (916) 363-2019
Amador, Calaveras, Tuolumne & San Joaquin Counties:
Contra Costa County:
Sutter, Yuba, Yolo, Placer & El Dorado Counties: