Client Forms

Workers’ Compensation Client Forms

Please click on the links below to access forms you may need throughout the workers’ compensation claims process. Contact Leep, Tescher, Helfman and Zanze‘s Redding-based team to schedule a free initial consultation by calling (530) 287-6674 or filling out the online contact form. Attorney Ben Helfman works with injured workers across Shasta County and all surrounding Northern California counties.

Forms:

• Application for Adjudication of Claim
  
• Declaration of Readiness
  
• Potential Client Questionnaire
  
• QME (Qualified Medical Evaluator) request form
  
• Medical Mileage Expense Forms