Were you injured in the accident? (Any pain or discomfort) *

Yes, I was injured

Helps us understand the impact on you and match you to the right attorney.

Were you at fault for the accident? *

Yes

No other driver involved (weather, road hazard, object, tree, etc.)

Determines which legal options and protections apply to your situation.

Do you already have an attorney for this case? *

Yes, and my case is already handled or settled

To prevent legal conflicts and ensure a firm can accept your case immediately.

Briefly describe the accident, what happened? *

Helps the attorney prepare the right strategy for your specific situation.

When did the accident happen? *To ensure your claim is filed within your state's Statute of Limitations deadlines.

What is your first and last name? *

So we know who to address in your free case evaluation.

What is your email address? *

Used for sending your case summary and follow-up information.

Lastly, what is your mobile number? *

Attorneys use this to reach you quickly with next steps. No spam. Please turn your phone on ring and be available to pick up!

By clicking “Submit,” you agree to receive calls and text messages from Personal Injury Counsel, its affiliates, and marketing partners about your inquiry. These may be sent with automated technology, including prerecorded messages. You agree that we may contact you at the phone number you provided, even if it is on a do-not-call list. Consent is not required to obtain services. You also agree to our use of electronic signatures, Privacy Policy, and Terms of Use.

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