Rella & Associates, P.C.
Attorneys at Law

300 Hamilton Avenue
Suite 202
White Plains, NY 10601
Phone: 866-785-4019
Fax: 914-287-2048

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* Denotes required field

Were you injured while working?

Yes
No

What were your injuries?

Did you have a pre-existing condition?

Yes
No

Have you filed a claim?

Yes
No

If so has your claim been accepted or denied?

Accepted
Denied

eg. xxx-xxx-xxxx


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