Step 1 of 15 6% Where did the incident occur? (State)(Required)AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificWe use this information to connect you with the right local attorney. What best describes your situation?(Required) I was hit by another vehicle I slipped, tripped or fell I was harmed due to medical negligence A dog or domesticated animal attacked me Other Help us understand the setting - where did it happen?(Required) On a public street or highway On private property (home, apartment, etc.) At a commercial location (business, store, restaurant, etc.) On government property (public building, school, park, etc.) At work / during work duties Other Date of Incident(Required) MM slash DD slash YYYY Try your best to remember around what time it happened. Were you at fault for the accident?(Required) Yes No Were you physically injured?(Required) Yes No Injuries don't often appear at the time of an accident. They can appear later on. That is why medical attention is recommended as soon as an accident occurs. What is the primary type of injury?(Required) Back or Neck Pain Head Injury Broken Bones Bites / Cuts / Bruises Other Did you receive medical attention?(Required) Yes No Did you obtain insurance / contact information of the other party involved?(Required) Yes No Were you insured at the time of the accident?(Required) Yes No Do you know if your policy includes Uninsured/Underinsured Motorist (UIM) coverage?(Required) Yes No Not Sure Briefly Describe What Happened(Required) Have you ever signed up with a law firm to help you with this case?(Required) Yes No Please enter your valid contact information — we’ll use it to send important next steps to connect you with a licensed attorney.Name(Required) First Last Email(Required) Phone(Required)Please enter a valid phone number. Terms and Conditions(Required) By submitting this form, you acknowledge and agree to the following: MyInjuryCheck.com is not a law firm and does not provide legal advice, legal representation, or legal services of any kind. The information you provide will be treated as strictly confidential and used solely for the purpose of connecting you with licensed attorneys who may be able to assist you. Submission of this form does not establish an attorney-client relationship, and no such relationship is formed until you formally retain legal counsel. MyInjuryCheck.com does not guarantee acceptance of your case by any attorney and makes no promises regarding legal outcomes. We route submissions to attorneys in our network based on the information you provide and availability. By continuing, you consent to the use and secure transmission of your information in accordance with these terms.
