Practice Areas

Christa R. Haggai, Attorney-at-Law

6033 W. Century Blvd., Suite 605
Los Angeles, California 90045
(310) 988-2420 VOICE
(213) 447-4743 DIRECT
(310) 988-2440 FAX

Name:
Date of Birth:
Marital Status
Address:
Health Insurance
Name Provider
Policy Number
Primary on the Policy
Phone Number
Home:
Cell:
Work:
Loss of Earnings:
Do you have a police report?
Facts
Get as much detail as possible about what happened and why they think they have a case. Ask as many questions as possible to get as much detail.
Email Address:(valid email required)
Today's Date:
What kind of Case:
Date of Loss:
Automobile Insurance
Name Provider
Policy Number
Primary on the Policy
Employer
Name:
Address:
Phone number:
Fax:
Email Address:
Type of Employment:
Who referred you to us?
Captcha:
Potential Defendant:
(Name, address and phone number of all potential defendants)
Damages:
(Type, identity and location of treating doctors and medical bills to day)