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How were you hurt?
Car Accident
Slip & Fall
On the Job
How were you hurt?
Car Accident
Slip & Fall
On the Job
Who was hurt?
I was hurt
A loved one was hurt
We were both hurt
Other
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Let’s start with a few questions
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Select Your Option
Personal Injury
Immigration
How were you hurt?
Car Accident
What was your role in the accident?
Driver
Passenger
Pedestrian/Bicyclist
Not Involved
Slip and Fall
Dog Bite
Bicycle Accident
While Working
Other
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What is your current immigration status in the U.S.?
No status in the U.S.
Tourist
Student
H-1B Visa Holder
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Who was hurt?
I was hurt
A loved one was hurt
We were both hurt
Other
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Are you currently in the U.S. legally?
Yes
No
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Date of the Accident
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What is your primary immigration goal?
Visiting the U.S.
Immigrating to the U.S.
Becoming a U.S. citizen
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Where did the accident occur?
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Are you married or in a domestic partnership?
Yes
No
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Was the accident your fault?
Yes
No
It was partially my fault
I'm not sure
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Do you have children?
Yes
No
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Not qualified
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Were you treated for your injuries?
I was treated at a hospital
I was treated at a Chiropractor's Office
Other
I was not treated
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Have you previously applied for any immigration benefits in the U.S.?
Yes
No
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Have you ever been deported or removed from the U.S.?
Yes
No
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Can you describe the injury?
Head Injury
Back/Spine Injury
Leg/Arm Injury
Broken Bones
Death
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Were the police, paramedics, or both called?
Police
Paramedics
Both
Neither
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Are you currently employed or attending school in the U.S.?
Yes
No
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Highest Level of Education
High School
Bachelor's Degree
Master's Degree
Ph.D.
Other
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Do you have health insurance?
Yes
No
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Current Employment Status
Employed
Unemployed
Self-Employed
Student
Other
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If involved in a car accident, do you have car insurance?
Yes
No
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Do you consent to our law firm contacting you regarding your case?
Yes
No
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Are you represented by a lawyer?
Yes
No
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Is there anything else we should know about your case?
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Is there anything else important we should know?
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