The People's Clinic Contact Form

Have you been injured by law enforcement in California within the last 6 months?

The People’s Clinic at the Lawyers Committee for Civil Rights (LCCRSF) provides free legal support to people who have been injured by law enforcement (police officers, sheriff’s deputies, or California Highway Patrolmen) and are interested in seeking compensation for their injuries in small claims court (meaning your damages are valued at $10,000 or less.) Unfortunately, we cannot support people who have claims against private security companies, or private actors (ie. a home health aide, relative, domestic partner, spouse etc.).

Please be aware that the legal team at The Peoples Clinic only provides limited scope legal consultation. We can assist you in filing claims, but we do not appear for you in court or at a hearing. If your claim requires a hearing, we can help prepare you to represent yourself in small claims court.

Please fill out this form to register for an appointment and a member of our team will contact you. 

Sign in to Google to save your progress. Learn more
Name (First, Last): *
Email address:
What is the best way to reach you? *
Primary Language: *
If answered "Other" (Please write which language)
When did your injury occur? Please estimate if you do not know the exact date. NOTE: Claims must be submitted within 6 months of injury. *
In what city and county were you injured? *
Which law enforcement agency caused your injury? For police officers or sheriffs, please include the specific city or county they work for. 

*Please note: The Peoples Clinic cannot support claims against private actors, such as home health aides, relatives, domestic partners, or spouses.
What happened to cause your injury? (Please describe what happened with as much detail as possible, including details about your injuries, such as physical injuries or property loss/damage.) *
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 LCCRSF's clinic to help address my legal issue, I am giving  LCCRSF my consent to share my information with others as reasonably needed in the judgment of LCCRSF to address my legal issue.
Date: *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy