Call Now For A Free Case Evaluation(908) 923-0020

Client Portal
Pezzano Law Group

Registration for Personal Injury Claims

Personal Injury

Motor Vehicle Accidents Only

Trip/Slip & Fall Accidents Only

Defendant’s Insurance

Injuries Sustained

Medical Treatment

Diagnosis (if known)

Treatment Received

Physical Therapy

Lost Wages:

Prior Injuries

I understand that the answers I provide will be used to prepare my case, and if I am not completely honest, it will negatively affect the results of my case.

Thank you. Your form has been submitted