Sinai
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Case Intake Form · Confidential
Step 1 of 5
Step 1 · Case Type
What type of legal matter do you need help with?
Select the option that best describes your situation. This helps us route your case to the right attorney.
🚗
Auto / Car Accident
Car crashes, rear-ends, hit and run
🚛
Trucking Accident
Semi-trucks, 18-wheelers, commercial vehicles
🏍️
Motorcycle Accident
Motorcycle or scooter collisions
⚠️
Slip & Fall
Falls on someone else's property
🏗️
Workplace Injury
On-the-job accidents and injuries
🏥
Medical Malpractice
Errors by doctors, hospitals, or providers
⚖️
Wrongful Death
Death caused by another party's negligence
Step 2 · Incident Details
Tell us about the incident.
Step 3 · Injury & Medical
Tell us about your injuries and medical care.
How would you describe the severity of your injuries?
Serious / life-altering
Major impact on daily life
Moderate
Required medical treatment
Minor
None / unsure
Did you visit an emergency room within 72 hours of the incident?
Yes
No
Are you currently receiving ongoing medical care?
Yes, regularly
Yes, occasionally
No, treatment complete
No treatment yet
Have you missed work due to your injuries?
Yes
More than a week
Yes
A few days
No
Step 4 · Insurance & Timeline
A few final questions about coverage and timing.
Is there an active insurance policy that may cover this claim?
Yes
No
Unknown
Have you already spoken to an insurance company about this incident?
Yes, and I gave a recorded statement
Yes, but no statement was made
No
Have you already hired an attorney for this matter?
Yes
No
Consulted
but not hired
Step 5 · Contact Information
How should we reach you?
An attorney will review your case and contact you within 24 hours.
First Name
Last Name
Phone Number
Email Address
Preferred contact method
📞 Phone call
💬 Text message
✉️ Email
Best time to reach you
Morning
8am – 12pm
Afternoon
12pm – 5pm
Evening
5pm – 8pm
Anytime
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Your case has been submitted.
Thank you. An attorney will review your information and reach out within 24 hours using your preferred contact method.