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Scheduling Appointment Form

Referral Source 

Patient Information

Provider Needed

Type of Injury
For PI, please indicate type of injury:

Medical Records

Upload File

If you cannot upload your files here, please email to info@socalinjuryliens.com  

Bodyparts Injured 

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We will send updates on new locations, physicians,  events, and other important news 

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SoCal Injury Liens

Tel. 833-4-LIENMD 

Direct: 949-205-3659 

                                           Info@socalinjuryliens.com                                                                          

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