Contact Us | Dallas Lawyer

First Name
Please enter your first name.
Last Name
Please enter your last name.
Phone
Please enter your phone number.

This isn't a valid phone number.
Email
Please enter your email address.

This isn't a valid email address.
Date of Accident
Accident Location
Please enter accident location.
Are you at fault?
- Yes
- No
Please make a selection.
Did you and the at-fault party exchange insurance information?
- Yes
- No
Please make a selection.
Is there a police report?
- Yes
- No
Please make a selection.
Is your vehicle drivable?
- Yes
- No
Please make a selection.
Do you have your own automobile insurance policy?
- Yes
- No
Please make a selection.
Claim Status (Check All That Apply)
- I have opened a claim with the at-fault party’s insurance.
- I have NOT opened a claim with the at-fault party’s insurance.
- I have opened a claim with the MY insurance.
- I have NOT opened a claim with the MY insurance.
- I don’t know who the insurance company is.
Tell us what happened in your own words.
Please enter a message.
Please describe your injuries.
Please enter a message.
Have you been in any motor vehicle accidents and/or sustained any work injuries requiring medical care within the last 10 years?
Please enter
Do you have health insurance?
- Yes
- No
Please make a selection.
Occupation
Please enter your occupation
Do you intend to pursue lost wages?
- Yes
- No
Please make a selection.
Did you go to the hospital after the accident?
- Yes
- No
Please make a selection.
Have you received any medical care since the accident?
- Yes
- No
Please make a selection.
Were you in the course and scope of your employment when the accident occurred?
- Yes
- No
Please make a selection.
Were there any witnesses?
- Yes
- No
Please make a selection.
On a scale of 1-10, how would you rate your current pain level?
Please enter pain level
Do you owe any outstanding child support in the State of Texas or any other state?
- Yes
- No
Please make a selection.
How did you hear about us?
Please enter your response
By submitting, you agree to be contacted about your request & other information using automated technology. Message frequency varies. Msg & data rates may apply. Text STOP to cancel. Acceptable Use Policy