Refer A Case

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Referring a Case

Complete the fields below or download a referral form and submit to: e-docs@bradfordbarthel.com.

Alternatively, mail or fax to:
Bradford & Barthel
P.O. Box 348450
Sacramento, CA 95833
(916) 569-0799 fax

Referred by (name)*
Referred by (email)*
Case Type
- Workers' Compensation
- ADR
- 132(a)
- S&W
- Covid
Claim No*
Date of Injury
MM slash DD slash YYYY
WCAB Case No
Claimant*
Claimant Address*
Date of Birth*
MM slash DD slash YYYY
SSN
Occupation
Employer*
Employer Address
Applicant's Attorney & Phone
Suggested Issues
- Injury
- Employment
- Occupation
- Coverage
- Earning
- TD
- PD
- Appointment
- Past Medical
- Future Medical
- Statute of Limitations
- Jurisdiction
- Dependency
- Rehabilitation
- Lien Resolution
- Other
Medical Evaluation
- Please Set
- Already Scheduled with Dr.
Date Scheduled
MM slash DD slash YYYY
- MSC
- PTC
- LIEN CONF.
- TRIAL
- DEPO
- OTHER
Date
MM slash DD slash YYYY
Time

: Hours

Minutes

AM/PM
Location
Judge
Remarks/Suggestions
Carrier Name
Administering for
Address
Street Address Address Line 2 City State ZIP Code
Adjuster Name
First Last
Phone
B&B Office Referring to
B&B Attorney Referring to
Additional Document Upload
Drop files here or

Max. file size: 50 MB, Max. files: 5.
Name
This field is for validation purposes and should be left unchanged.

Δ

*Note there are 7 required fields

PO Box 348450
Sacramento, California 95834
(916) 569-0790
contactus@bradfordbarthel.com

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