Get Matched to Top Local Lawyers
Complete these questions and get a customized, timely response from prescreened and member referred Lawyers that are interested in working with you. You choose the Lawyer that best meets your needs. No Cost.
1) What was the date of the accident?  [required]
2) Were you a passenger or the driver?  [required]
3) Please provide a brief description of the accident:  [required]
4) If you were the driver, are you the owner of the vehicle?
Yes  No
5) If you are the owner of the vehicle, does your automobile insurance limit liability?
6) If you are the owner of the vehicle, does your automobile insurance limit uninsured motorist coverage?
7) If you are the owner of the vehicle, does your automobile insurance limit medical payment benefits?
8) Did you file a claim?  [required]
Yes  No
9) Was a police report filed?  [required]
10) Were there any witnesses?  [required]
11) If yes, do you know how to contact these witnesses?
Yes  No
12) Were you injured?  [required]
13) If yes, were you taken to the hospital by ambulance?
Yes  No
14) Were you treated in an emergency room?
Yes  No
15) Were you employed at the time of the accident?  [required]
Yes  No
16) If yes, has a worker's compensation claim been opened?
Yes  No
17) Have you been involved in an accident before?  [required]
Yes  No
18) Please indicate how you would prefer to to pay for the services of an attorney, should you hire one to help you with your legal matter. Note: there is no charge to sumbit your request.  [required]
Hourly Rate
Retainer
Flat Fee
Contingency
Not Sure
19) Comments or Details:

I want responses from Lawyers that serve:  [required]
20)
ZIP Code:  -- OR --
City/State 

Contact Information:
21)
First Name: [required]
 Last Name: [required]
22)Email Address: [required]
23)
Day Time Phone: [required]
()-x		 Evening Phone:
()-
24)
Best Time: [required]

Terms of Service
25)I acknowledge that I have read and I agree to the TERMS AND CONDITIONS of this service [required]

Do not send confidential information via this service, as others may intercept it. No attorney-client relationship is created and the information is not privileged or confidential. Respond.com or any of its network or affiliate sites do not offer legal advice or receive any legal fees. This is not a Lawyer Referral Service. You are responsible for selecting an attorney. Attorneys are not obligated to take your matter merely because you sent it through the service or because they responded to your request
IF YOU NEED ASSISTANCE FILLING OUT THIS FORM,
PLEASE CALL 703-651-2060
(Monday - Friday 9am - 6pm EST)


 
 

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Auto Accidents
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