PA Car Accident
Pennsylvania Auto Accident Lawyers and Attorneys.

Injured in a automobile accident in Pennsylvania? You may be entitled to bring a legal case and recover monetary damages.

If you need an attorney for a car accident injury claim in Pennsylvania, please fill out the information below and a lawyer will usually respond to you within a few hours of your email. Our attorneys handle claims throughout PA. Free Confidential Legal Advice. Please read and agree to our terms.

Title:

First Name:

  M. I.

  

 Last Name:

 Address:

 City:

 State:

 Zip Code:

 Phone Number (day):

 Phone Number (eve):

Email Address

 If this inquiry is not for yourself, please tell us the name of the person?:

 Title:

  

First Name:

   MI

  

Last Name:

What is the Injured's relationship to you?:

Injured's Date of Birth?
(ie . mm/dd/19yy)

Have you or they been been in an auto accident?:

 Yes No
Date of accident?
(ie . mm/dd/19yy)

 What city and state did the accident occur in?

  What were your Injuries?

What type of medical treatment was received?

Who was responsible for the accident? 

Was the person(s) injured wearing a seat belt? 

Did the Police respond to the accident? 

 Yes No

Did anyone recieve a ticket?

 Yes No

Did the other driver have insurance?

 Yes No

 Do you have insurance?

 Yes No

 Do your currently have an attorney?

 Yes No

Describe your injuries and Accident.

 
 I understand that submitting this form does not create an attorney client relationship: Agree


Submit by pressing button below






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