Forms for our clients
Below are some forms we recommend that you complete. Let our experienced attorney help you.
Client forms:
New Client Information Packet — Workers’ Compensation
Worker’s Compensation Claim Form
Client Information Sheet
Fee Disclosure Statement
HIPAA Compliant Authorization To Release Medical Records/Notes
Declaration Pursuant to Labor Code Section 4906(g)
New Client Information Packet – Personal Injury
FMLA
Medical Mileage Reimbursement Forms (in English and Spanish):
For travel on or after 1/1/26
For travel on or after 1/1/25
For travel on or after 1/1/24
For travel on or after 1/1/23
For travel on or after 1/1/22
For travel on or after 1/1/21
For travel on or after 1/1/20
For travel on or after 1/1/19
For travel on or after 1/1/18
For travel on or after 1/1/17
For travel on or after 1/1/16
For travel on or after 1/1/15
For travel on or after 1/1/14
for travel on or after 1/1/13
Fact Sheets
Fact Sheet A : Answers to your questions about utilization review
Fact Sheet B : Glossary of workers’ compensation terms for injured workers
Fact Sheet C : Answers to your questions about temporary disability benefits
Fact Sheet D : Answers to your questions about permanent disability benefits
Fact Sheet E : Answers to your questions about qualified medical evaluations and agreed medical evaluations
Fact Sheet F : Answers to your questions about the state’s Uninsured Employers Benefits Trust Fund