InicioCuéntenos sobre su accidente Cuéntenos sobre su accidente Cuatro pasos breves, unos cinco minutos. Sus respuestas se cifran y solo las leen la abogada Elham Azimy y el personal de admisión del despacho. 1Your accident2Injuries and what happened3How to reach you4Review and consent Leave this field empty Step 1 of 4 Your accident What kind of accident was it? * Choose the closest match. “Other / not sure” is fine. Choose…Rear-endedT-bone / side-impactSideswipedHead-on collisionHit-and-runMulti-vehicle collisionRideshare (Uber / Lyft)Commercial truck collisionMotorcycle collisionPedestrian collisionBicycle collisionOther / not sure When did it happen? * An approximate date is fine. The deadline to bring a claim depends on it. This date is approximate City or area where it happened * State * Choose…ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY ZIP code of the crash location (optional) Street, freeway or intersection (optional) Continue Step 2 of 4 Injuries and what happened How were you involved? * DriverPassengerRideshare passengerMotorcyclistPedestrianBicyclist or scooter riderOther Were you (or the person you are asking for) injured? * Many injuries show up a day or two later. “Not sure” is an honest answer. YesNoNot sure Where were you hurt? Check all that apply. HeadNeckBackShoulderArm, wrist or handChest or ribsHip or pelvisLeg or kneeFoot or ankleInternal injuriesOther or not sure Did an ambulance respond? YesNoNot sure Did you go to an emergency room or urgent care? YesNoNot sure Have you seen any other doctor, chiropractor or physical therapist? YesNoNot sure Is treatment ongoing? YesNoNot sure Describe the injuries (optional) Do you believe someone else was at fault? * California reduces, but does not eliminate, a claim when fault is shared. YesNoNot sure What happened? * A few sentences in your own words: where you were, what the other vehicle did, what happened next. Was a police report made? * YesNoNot sure Report number (optional) Who do you believe was responsible? (optional) e.g. the other driver, a rideshare driver, a trucking company, a city bus. Do you already have an attorney for this accident? * If you do, please contact them first; we do not take over cases where another attorney already represents you. YesNo BackContinue Step 3 of 4 How to reach you First name * Last name * Mobile phone * We usually call or text first. Email * Street address * Used for conflict checks and any required written disclosures. City * State * Choose…ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY ZIP * Preferred contact method * Choose…Phone callText messageEmail Best time to reach you * Choose…Any timeMorningAfternoonEvening BackContinue Step 4 of 4 A few last questions and your permission Do you have the other party’s insurance information? YesNoNot sure Has an insurance claim already been opened? YesNoNot sure Was a commercial vehicle involved (truck, bus, rideshare, delivery)? YesNoNot sure Were you working at the time of the accident? YesNoNot sure Review your answers Your permission * I understand that submitting this form asks California Crash Law to review my inquiry; it does not create an attorney-client relationship, guarantee representation, or stop any legal deadline. I agree to the Privacy Policy and Terms, and I agree to be contacted about this inquiry by phone, email, or text message at the contact details I provided; message and data rates may apply, and I can reply STOP to end text messages. My case details will not be sent to an outside law firm without my separate authorization unless otherwise permitted or required by law. Optional: send me occasional educational emails about California accident claims. I can unsubscribe at any time. This is not required to submit my inquiry. Read the privacy policy, terms and legal disclaimer. Important: Submitting this form requests a review of your inquiry; it does not create an attorney-client relationship, guarantee representation, or stop any legal deadline. Do not use this form for emergencies or send Social Security numbers, financial account details, or medical records. A lawyer may have duties to protect information provided by a prospective client even if no representation begins. We will contact you about this inquiry using the information you provide. We will not send your case details to an outside law firm for possible representation without your authorization unless otherwise permitted or required by law. BackSubmit my inquiry