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Category 2:
Personal Injury and/or Wrongful Death
You need a lawyer to help you with a claim for injuries or
death on your behalf or on behalf of a friend or family member.
We have great lawyers that can help you with your injury or death case.
Tell us how the claim arose, and we will try to help.
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Are you looking for a lawyer for yourself or for someone else?* |
Myself |
Someone Else |
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If you are looking for a lawyer for someone else, is it a friend or
family relation? |
Friend |
Family Member |
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Did the injury or death result from a motor vehicle accident?* |
Yes |
No |
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If the injury or death resulted from an accident that was not a car
or motor vehicle accident, describe as best you can very briefly what
type of accident caused the injury or death. |
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What was the approximate date of the accident causing the injury or
death?* |
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Did the accident cause an injury or a death?* |
Injury |
Death |
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If the accident caused an injury, briefly describe as best you can
what personal injuries were suffered. |
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Did the injured person go to a hospital or doctor?* |
Doctor
Hospital
Both |
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Do you know the name of the other person or company who caused the
accident?* |
Yes |
No |
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If "Yes," please give the name: |
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If "No," how can this person or company be located so the lawyer can
pursue a claim for you? |
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Please identify the insurance company of the person who caused the
injuries, if you know its identity: |
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Please identify where the accident occurred*: |
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Has the injured person missed any work, or is the injured person
expected to miss any work?* |
Yes |
No |
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If yes, how much work will be missed and how much does the injured
person earn per week? |
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If you know, approximately how much are the medical bills for the
injured person at this time? |
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Please enter your full name* |
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Please enter your email address* |
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Please re-enter your email address* |
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Mailing Address* (Street, City, State,
Zip Code) |
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Home Phone* (include
area code) |
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Cell Phone |
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Work Phone* (include
area code) |
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Note: Initially, LawyersYouNeed.com will only
provide your e-mail address to the lawyers who may be interested in
discussing your legal situation with you. Your mailing address and
telephone numbers will not be disclosed unless the attorneys certify
that there is a problem or malfunction with receiving or sending e-mail
to you. |
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You must agree to the following
Basic
Agreement and Terms of Use: |
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To submit this form, please enter the characters you see in the image |
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