Take Back Control After Your Accident.

Expert legal guidance from attorneys who understand your situation

Full Name

Phone Number

Email Address

State

Date of Accident

Type of Injury

Length of Hospital Stay (days, if applicable)

Are you still receiving medical treatment?

Was your vehicle damaged?

Brief Description of the Accident

By entering my telephone number and submitting this form, I provide my prior express written consent to receive calls, including autodialed calls, prerecorded or artificial voice messages, and text messages, from GuardianCore Solutions LLC and its affiliated law firms or legal service providers (see list), regarding legal services for motor vehicle accidents, personal injury claims, or related matters at the number provided. I understand that agreeing to receive these communications is not required to submit this form or obtain legal services, and I may revoke my consent at any time by texting "STOP," calling (800) 987-6543, or visiting legal-advocates.com/opt-out.

*All fields are required except hospital stay

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