First Name * Last Name * Phone Number * Email * Address Address2 City State Zip
Do you already have an attorney to help you submit this claim ?(Default to 'No') NoYes
× 8 = sixteen
* By clicking above, you agree to receive telephone calls, emails, voicemails and text messages by one or more legal service providers, even if you are on the “Do Not Call” registry, for the purposes of determining case qualification. You also agree that you are not currently represented by another lawyer for your legal matter. I understand I may revoke my consent to be contacted at any time and that my information is not sold or disclosed other than the purpose to determine the viability of my claim. Injury Help Desk is a matching service only and is not otherwise affiliated with or responsible for the representations or services provided by companies with which you are matched. Legal services for your matter may not be available in all states. All calls are confidential. Prior results do not guarantee a similar outcome. Free background information is available upon request. I freely submit my information and agree to be contacted by one or more members of the legal team to determine whether I might qualify to participate in this lawsuit.