JASINSKA LAW FIRM PC
245 Fischer Ave., Suite D-2
Costa Mesa, CA 92626
Phone: 866-248-0535 Fax: 949-818-5113
Thank you so much for contacting our law office! Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

Your Social Security Number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

Social Security Numbers are most often used to positively identify parties. Most courts require Social Security Numbers of all parties in a case. Some other examples of how this information may be used include:
  • initial service
  • in court orders
  • in required reports or other documents filed with the State

The attorney will need to obtain information about you and the matter for which you seek consultation to determine if our office can provide legal services to you. Any information received during the consultation will be treated as confidential and will not be used or revealed by our office without your consent, except as provided by law and the California Rules of Professional Conduct. Our office may be unable to represent you if your interests conflict with those of a client of this firm, of others to whom we also owe a responsibility, or of the interests of a member of this firm. Please know that we may also choose to decline to represent you, or you may wish not to be represented by this firm.

If you have any questions, please don't hesitate to contact our law office. The best way to communicate with an attorney is through email. We look forward to working with you!

Please email me all the evidence you have that supports your claim. Please think of the communication you had with the other party, any history, and your position. Please list names, dates, and pertinent details about your legal matter. Please attach any documents or background information related to your claim. Please scan and email your medical records, police reports, investigation reports, photographs, videos, records in any related proceedings, and witness statements. 
We need the information to perform a conflict check. Please provide as much detail as possible. 

Contact information

Emails
*
Upon submission, a copy of this form will be sent to the primary email.
Addresses
Phone numbers

Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We will contact you as soon as possible with any updates.

Please click the SUBMIT button below when you have finished answering all questions.