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Fill out the information below so our team can review your accident details and connect you with a trusted legal professional. Once you submit your information, one of our representatives will call you within 24 hours to discuss your case and answer any questions you may have.

First Name

Enter the first name of the injured person.

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Last Name

Enter the last name of the injured person.

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Type of Injury

Please specify the type of injury sustained.

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Did the injured person receive treatment?

Select if treatment was received.

Treated at a hospital

Treated at a doctor’s office

Was not treated

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Was a police report filed?

Indicate if a police report was filed.

Yes

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Did the police report say you are at fault?

Indicate if the police report indicated fault.

Yes

Both at fault

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Are you currently represented by a lawyer for this case?

Indicate if you are currently represented by a lawyer.

Yes

I was, but not anymore

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When did the accident happen?

Select when the accident occurred.

Within the last 30 days

Within the last year

Within the last 2 years

More than 2 years

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Address

Enter the address of the injured person.

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Phone Number

Enter a valid phone number.

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Email Address

Enter a valid email address for contact.

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Consent

By clicking “Submit,” you agree and consent to the following: You are requesting a free case review and authorizing MyInjurySettlement.com to share the information you provide with its network of intake specialists and attorneys so they can contact you about your potential claim. You understand this may be considered attorney advertising. My Injury Settlement is not a law firm and does not provide legal advice. Any attorney-client relationship may only be established between you and the attorney you choose to engage. You authorize MyInjurySettlement.com and its partners to contact you at the phone number and email address you provide, including by text, phone call, prerecorded message, or automated dialing system, even if your number is on a federal, state, or corporate Do Not Call list. Message and data rates may apply. Your information will be kept private and used only for the purpose of evaluating your inquiry and connecting you with legal help. You can withdraw your consent at any time.

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