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Hurt in a car crash? Tell us what happened.

Drivers, passengers, pedestrians, cyclists and motorcyclists. It takes about two minutes, and someone from our office will contact you, usually within one business day. There is no charge to have your crash reviewed.

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1 of 3The crash

Date of the crashAn estimate is fine.

City where it happened

You were the…

DriverPassengerRideshare passenger (Uber/Lyft)PedestrianBicyclistMotorcyclist

What kind of crash was it?

Rear-endedHit from the side (T-bone)Head-onSideswipe or lane changeLeft turnHit while parked or stoppedSeveral vehiclesOther

What hit you, or what did you hit?

Car, SUV or pickupBig rig or commercial truckCompany or work vehicleBusUber or LyftMotorcycleNot sure

Who do you think caused it?

The other driverMeBoth of usNot sure

Did the other driver have insurance?

YesNoThey drove off (hit and run)Not sure

Do you have car insurance of your own?

YesNoNot sure

Did the police come or make a report?

YesNoNot sure

How bad was the damage to your vehicle?

MinorModerateSevere or totaled

Did the airbags go off?

YesNoNot sure

Do you have photos of the vehicles or the scene?

YesNoNot sure

Was a city bus, government vehicle, public employee or a road problem involved?

YesNoNot sure

In your own words, what happened?Two or three sentences is plenty.

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2 of 3Your injuries

Were you hurt?

YesNoNot sure

Where does it hurt?

Tick all that apply.

HeadNeckUpper backLower backShoulderArm or elbowWrist or handChest or ribsStomachHipLeg or kneeAnkle or foot

What medical care have you had?

Tick all that apply.

Ambulance from the sceneEmergency roomAdmitted to the hospitalUrgent care or my doctorChiropractor or physical therapyX-ray, CT or MRISurgery (done or recommended)No treatment yet

Have you missed work because of your injuries?

YesNoI'm not working

Do you already have a lawyer for this crash?

YesNoNot sure

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3 of 3How we reach you

First name

Last name

Phone

Email

Best way to reach you

Phone callText messageEmail

Language

EnglishSpanishOther

I agree that Ari Friedman Law Offices, PC may contact me about this inquiry by phone call, text message or email at the number and address I entered, including by automated means. Message and data rates may apply. Reply STOP to stop texts. Consent is not a condition of any service.

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Sending this form does not make us your lawyers, and we are not your lawyers until we agree in writing to take your case. Please do not send anything confidential here. Deadlines for injury claims in California can be short — as little as six months when a city bus or other government vehicle is involved — so do not wait for us to reply if a deadline is close. Ari Friedman Law Offices, PC. See our privacy policy.