Apply for Representation

Thank you for taking the time to tell us about your case! We know your time is valuable, and we’ve worked really hard to streamline this Application. Once you finish and click “Submit,” we’ll be back with you quickly—usually within one business day.

Please start by answering the questions below. (Try not to use the “back” button until you’ve finished and clicked “Submit” because it could make you start over.) For legal reasons, we have to tell you this: filling out the application doesn’t automatically make us your lawyers, and we can’t promise for certain that we can find a lawyer for every case. As you probably know, you aren’t represented by a lawyer unless and until you sign a written agreement with that lawyer’s firm.

1PERSONAL DETAILS

2TELL US ABOUT WHAT HAPPENED

3TELL US ABOUT THE CONSEQUENCES

4FINISHING UP

Name

First Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

What best describes your case type? *(Required)

If more than one option applies to your case, choose the option that fits best.

Are you currently represented by a lawyer?

Yes

Are you filling out this Application for yourself or someone else?

Myself

Someone Else

It's perfectly fine to fill this Application out for a family member or someone you care about.

Who are you filling out this Application for?

Please tell us the person's name and your relationship to that person. For instance, you might write, "John Doe, my father."

As you go forward, fill the Application out as though you ARE the person you're filling it out for. For instance, if a question asked "were you hurt?" and the person you're filling this out for was hurt, then you'd answer "yes."

Got It

Tell us about what happened.

When did the collision happen?

MM slash DD slash YYYY

If you're not exactly sure, give your best estimate.

Were you a driver or a passenger?

Driver

Passenger

Who was at fault for the collision?

The driver of another vehicle

The driver of my vehicle

Both

I don't know

Who was at fault for the collision?

the Uber, Lyft, or rideshare driver

the driver of another vehicle

Both

I don't know

What did the truck driver do to cause the accident?

What did the at-fault driver do to cause the car accident?

What did the driver do to cause the accident?

What did the at-fault driver do to cause the bicycle accident?

What did the at-fault driver do to cause the motorcycle accident?

What did the driver who was most at fault do to cause the Uber, Lyft, or rideshare accident?

What did the Uber, Lyft, or rideshare driver do to cause the Uber, Lyft, or rideshare accident?

What did the at-fault driver do to cause the Uber, Lyft, or rideshare accident?

What did the at-fault driver do?

It looks like you chose "other." Tell us what happened.

Please tell us where you were when the collision happened.

For instance, in a crosswalk, on a sidewalk, pumping gas, crossing a street that had no crosswalk, getting the mail, walking on the shoulder of the road, etc.

Did the police come to the scene of the collision?

Yes

I don't know

Did the police give a ticket to the driver who was at fault?

Yes

I don't know

In some cases, a driver's actions can be so bad that he or she could be held responsible for punitive damages. Please check any of the boxes below that apply to what the at-fault driver did. If none of these apply or if you don't know, leave them blank.

driving under the influence of alcohol or drugs

texting or typing while driving

hit and run

other INTENTIONAL misconduct

It looks like you chose "other intentional misconduct." What was it?

Did the airbags in your vehicle go off?

Yes

I don't know

Was Uber, Lyft, or another rideshare service involved?

Yes

I don't know

What city or county did the collision happen in?

Sexual assault is awful, and nobody should have to experience it. A sexual assault can destroy a person’s sense of security and even make the victim wonder if she or he did something wrong. Talking about sexual assault is hard. We thank you for having the courage to come forward.

When did the assault happen?

Be specific if you can. If it happened multiple times, please list the occasions that you remember, or give a range of dates.

Who was the attacker?

What was the attacker's relationship to you, if any?

For instance, complete stranger, boyfriend, teacher, therapist, security guard, pastor, friend of a friend, etc.

Where did it happen?

For instance, my apartment, a friend's house, outside a restaurant, at my school, in his car, etc.

How old were you when it happened?

What city or county did it happen in?

When did the shooting or violent crime happen?

If you aren't sure of the exact date, give your best estimate.

What happened?

shooting

stabbing

hitting or beating

something else

What was it?

Where did it happen?

For instance, at my apartment complex, in a restaurant, at a gas station, at a friend's house, etc.

Who was the attacker, if you know?

What was the attacker's relationship to you, if any?

For instance, total stranger, friend of a friend, acquaintance, etc.

How did it happen?

Were the police or other authorities notified?

Yes

I don't know

Did the police catch the attacker?

Yes

I don't know

What city or county did the attack happen in?

When did the fall happen?

MM slash DD slash YYYY

If you don't have the exact date, give your best estimate.

Where did the fall happen?

commercial area (like a store, gas station, restaurant, stadium, etc.)

apartment or hotel

sidewalk

private home

someplace else

Where did it happen?

Did you speak with a manager or employee, or make a report?

Yes

If a report was made, do you have a copy?

Yes

What caused you to fall?

Be specific, if you can. For instance, broken stair, puddle of water, uneven sidewalk, boxes left in hall, etc.

What city or county did the fall happen in?

Is there anything else you'd like to tell us at this stage about what caused the fall?

If not, that's okay—you can leave this blank.

When did the product failure happen?

MM slash DD slash YYYY

If you don't have an exact date, give your best estimate.

What kind of product failed?

Be as specific if you can. The brand name and model are important. For instance, Jeep Liberty SUV, Firestone Wilderness tire, Vitamix pro blender, Poulan chainsaw, etc.

When did you buy the product?

Where did you buy the product?

If you bought it used, please let us know.

What were you doing when the product failed?

What made you think something was wrong with the product?

What city or county did the product fail in?

Is there anything else you'd like to tell us at this stage about the product itself?

If not, that's okay—you can leave this blank.

When did the injury happen?

What company or person were you working for?

What was your job title?

Were you working with machinery when you got hurt?

Yes

What were you doing at the moment you got hurt?

Approximately how many employees did your employer have?

What city or county were you hurt in?

When did it happen?

If you don't have an exact date, give your best estimate.

Who did something wrong, illegal, or dangerous?

If you don't have an exact date, give your best estimate.

What happened?

What city or county did it happen in?

If you don't have an exact date, give your best estimate.

Is there anything else you'd like to tell us at this stage?

If not, that's okay—you can leave this blank.

Tell us about the consequences.

If you are filling out this Application because someone you care about was killed, select "yes" below and skip the rest of this page.

Yes

Have you seen doctors, received medical treatment, or received therapy?

Yes

What kind of medical treatment have you received? (Check all that apply.)

hospital / emergency room

urgent care facility

primary care physician

orthopedic doctor (any specialty)

family / internal medicine doctor

neurologist

psychologist

physical therapist

chiropractor

workers' compensation doctor

Other

Were you taken to the hospital by an ambulance or medical helicopter?

Yes

I don't Know

It looks like you checked the box for "other." Who else did you see for treatment?

Have you had surgery?

Yes

Is future surgery likely?

Yes

I don't know

Did you lose consciousness during or after the collision?

Yes

I don't know

If you hit your head during the fall, did you lose consciousness?

Yes

I don't know

Please tell us what parts of your body were injured, and what those injuries were.

Was anyone else hurt?

Yes

I don't know

Who else was hurt, and what is that person's relationship to you?

For instance, "Jane Doe, my sister."

What happened? Please be as specific as you're comfortable being.

Details that would be helpful include what the sexual act was, whether penetration occurred, what was said before and after, what happened before and after, etc.

Have the police been notified?

Yes

I don't know

Did the police arrest the attacker?

Yes

I don't know

Have you received any therapy or medical treatment?

Yes

I don't know

Where did you receive therapy or treatment?

Is there anything else you'd like to tell us at this stage?

If not, that's okay—you can leave this blank.

Were you or someone you care about injured?

Yes

I don't know

Did it cause monetary or financial loss to someone?

Yes

I don't know

Is there anything else you think we should know?

If not, that's okay—you can leave this blank.

Tell us about the effects on you or others. This is what the law calls "damages."

Finishing Up

We hope we can take your case! But IF our firm isn't a good fit for your case, we can usually find another good lawyer who can help. If it turns out that we can't take your case, should we do that for you?

Yes

If you choose “yes,” we’ll share the facts of your case with that lawyer and ask him or her to contact you. You'll usually hear from that lawyer on the same day you hear from us.

How did you find out about our law firm?

How did you hear about us?

Who told you about us? We'd like to send that person a thank-you note!

What words did you put into Google or another search engine?

Why did you choose us instead of another law firm?

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Thank you for taking the time to share your case with us. To finish, click "Submit" below. We’ll get back in touch with you as soon as possible, usually within one business day.

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