LCCRSF The People's Clinic Intake
Were you injured by California police or another government agency? Lawyers' Committee for Civil Rights of the San Francisco Bay Area (LCCRSF) is providing free support to those interested in pursuing personal injury compensation in small claims actions against law enforcement.

Please fill out this form to register for an appointment with the Small Claims Personal Injury Clinic Intake brought to you by the Lawyers' Committee for Civil Rights of the San Francisco Bay Area and GLIDE.

*PLEASE NOTE: You have 6 months from the date of injury to file a claim against a government entity.*
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Name: *
Email address:
Phone:
What is the best way to reach you?
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Primary Language: *
When did your injury occur? Please estimate if you do not know the exact date. *
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In what city and county were you injured? *
What happened to cause your injury? Please include details about your injuries (including property loss/damage) and the parties involved. *
Do you have any pending criminal charges? *
This is important for us to know so that we can work with your criminal defense attorney if appropriate. It does not affect your ability to receive assistance.
If so, what is the name and number of your public defender or criminal defense attorney?
How did you learn about our clinic?
Legal Consent - Please Read Carefully and Sign: *
You are here to receive legal information, referrals and advice only from Lawyers’ Committee for Civil Rights of the San Francisco Bay Area (LCCRSF). LCCRSF is not agreeing to represent you in any matter and is not agreeing to appear for you in court or at a hearing. You remain responsible for your legal issues unless you find an attorney who agrees to represent you. Due to the short-term and limited nature of the legal services provided today, it is not possible for LCCRSF to systematically screen for conflicts of interest. By signing below, you are informed, understand, and waive all unknown conflicts of interest that may arise while receiving limited legal services today. I understand that by asking GLIDE’s clinic to help address my legal issue, I am giving GLIDE and LCCRSF my consent to share my information with others as reasonably needed in the judgment of GLIDE and LCCRSF to address my legal issue.
Date: *
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Prepared By LCCRSF Staff
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