Important - Many personal injury law cases require action within a limited time-frame, called a statute of limitation. Please speak with your selected attorney for more information.

I am seeking legal assistance to:

Make a claim for an injury

Defend against a claim for injury made by someone else

The claimed injury occurred on this date:

The claimed injury occurred at this location:

The claimed nature of injuries is:

Lower back pain

Upper back pain

Shoulder pain

Neck pain

Headaches

Nausea

Difficulty sleeping

Anxiety

Cuts and bruises

Broken bones

Loss of feeling in part of body

Difficulty breathing

Impaired vision

Memory loss

The injured party believes they have insurance that will cover this injury:

Yes

I don't know

The injured party believes that the other party has insurance that will cover this injury:

Yes

I don't know

There are witnesses to the injury whose names the injured party knows or will know soon:

If yes,Number of witnesses:

The status of medical treatment is:

No treatment yet

Still receiving treatment

Stopped treatment but need to restart

Treatment completed

I don't know

If medical treatment has begun, which medical practitioners have been seen?:

Medical doctor

Surgeon

Chiropractor

Acupuncturist

Physical therapist

The medical costs to date are approximately:

I don't know

There are no medical costs

Occupation:

The injured party missed this time from work or will likely miss this time from work because of the injury:

No work missed

This number of work days:

This number of work months:

Injured person will return to work on this date:

Injured person is still receiving treatment and is unsure when will return to work

I don't know

This number of work days:

This number of work months:

Injured person will return to work on this date:

Amount of lost work income to date is:

No lost work income

I don't know

Your Age:

Current status of the claim is:

No action taken yet

Demand for compensation made

Lawsuit filed

How well do you understand your legal situation or issue? Please select the statement that best applies to your situation:

I understand my legal issue.

I have a couple of questions.

Gross annual income:

$25,000 or less

$25,001-$50,000

$75,001-$100,000

$100,001-$125,000

$125,000+

One Line Summary of your Case: *

Describe your Case in Detail: *

First Name *

Last Name *

City *

State or Province *

Zip / Postcode *

Phone *

Email *

Contact Preferences

Release my contact infoto Attorneys *

Yes

Notify me when attorneys respond by: *

Text Message

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What level of experience would you like your attorneyto have?

No preference

6-15 years experience

1-5 years experience

over 16 years of experience

How Will You Pay?

Cash

Credit Card

Family

Check

Friend

I can't pay.