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Jennifer Perez

Paralegal

jennifer-perez

Schedule A Free Case Evaluation

Fill out the form below for a free case evaluation.

1

2About You

3About Your Injury

Were you injured as a federal worker?*
- No
- Yes

Full Name*
Email Address*
Phone Number*
Best Time To Contact You
- Mornings (9-11AM)
- Afternoons (11AM-2PM)
- Evenings (2PM-5PM)
Address*
Street Address Address Line 2 City State ZIP Code
How did you hear about HammondTownsend?*
Select all that apply
- TV
- Google
- Social Media
- Radio
- Friend/Family
- Doctor
- Another Lawyer
- I'm A Former Client
Who Referred You?*
Have More Info To Give?*
Start the process by providing us with more information on your injury. You can either do this online in the questions that follow or we can call you to gather this info. The choice is yours.
- I'm ready to fill out more info (Speed Up Your Evaluation Process)
- Please call me to get more info

Have you filed a claim with the Virginia Workers' Compensation Commission?*
- Yes
- No
What is your Jurisdiction Claim Number (JCN)?
This can be found on any correspondence from the VWCC. It should start with VA.
Date of Injury*
MM slash DD slash YYYY
Employer/Company Name
Place of Accident
How did the accident occur and what injuries did you sustain?*

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