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Law Office of Vincent Marletta 

Workers' Compensation Law

Address: 2039 Kala Bagai Way, Ste 400, Berkeley CA 94704

Tel: (510) 843-6050 | Fax: (510) 843 6061 | Email: info@marlettaworkcomp.com

Support Group Session
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New Client Intake Form

Please fill out the below intake form to the best of your ability. Once received, we will reach out to you to schedule a time to talk with the Attorney.

Multi-line address

Employer Address

Multi-line address
Have You Filed a Claim
Yes
No
Was The Claim Denied
Yes
No
Are You Currently Recieving Benifits
Yes
No
Have You Been Elavuated by Qualified Medical Examiner (QME)
Yes
No
Have You Had Previous Claims
Yes
No
Was the Previous Claim to The Same Body Part
Yes
No
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