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iPlease Read Before You Begin

Answer each question accurately. Your responses and available accident documentation help determine whether your information may meet the current initial criteria.

Secure Online Intake

Check your initial eligibility

Answer a few focused questions about the accident, your injuries, treatment, and available documentation. Your information is reviewed securely against the current initial criteria.

↻Progress saves automaticallyYour completed answers are saved on this browser so you can return and continue.

Tell Us About Your Accident

Start with when and where the accident happened and the type of collision.

1. When did the accident happen? *
7. What type of motor vehicle accident occurred? *
8. What was your role in the accident? *
9. Was another vehicle or driver involved? *
10. Was another driver at fault for the accident? *

Injuries & Qualification

Tell us about your injuries, treatment, police report, and current claim status.

11. Were you injured in the accident? *
13. Did you receive medical treatment for your injuries? *
15. Were you admitted to a hospital? *
Optional report status
16. Do you currently have a police report for this accident? (Optional)

You can continue whether you currently have the report or not. The final step asks the required buyer-qualification question about whether you are willing to provide a copy later if requested.

18. Have you already received a bodily injury settlement for this accident? *

Vehicle & Insurance

Provide the vehicle and insurance details available to you.

22. Was your vehicle damaged in the accident? *
23. Do you have photographs of the vehicle damage? *
24. Did you have auto insurance at the time of the accident? *
25. Have you filed an insurance claim for this accident? (Optional)
26. Have you hired an attorney for this accident? *

Your Contact Information

Enter accurate contact information so our team can reach you about this inquiry.

29. Gender *
30. Preferred Contact Time *

Review & Consent

Review your information, confirm accuracy, and choose your communication preferences.

Is the information you provided about this accident accurate to the best of your knowledge? *
Are you willing to speak with our verification team by phone to confirm your accident information? *
What is the best time for our team to contact you? *
Final eligibility question • Required
If requested by the law firm, are you willing to provide a copy of the police report? *
Optional document upload

Police Report — PDF or Image

If you already have the police report, you can submit the PDF/image here. The file itself is optional at intake and does not control eligibility. Eligibility is based only on the visible answer options the administrator has explicitly marked Eligible or Reject.

Current report statusNot provided / optionalWilling to provide if requested: Not answered
NoteAccepted: PDF, JPG/JPEG, PNG, WEBP • Maximum 10 MB. Upload is optional at intake. If you resume later, reselect the file because browsers do not keep file selections.

The SMS checkbox is optional, unchecked by default, and is not required to submit this form.

By clicking Check My Eligibility, you confirm the information provided is accurate and authorize US Accident Help and applicable service partners to contact you by phone or email about this inquiry as permitted by law. Text messages are authorized only if you separately select the optional SMS consent above. Submitting this form does not create an attorney-client relationship. Review our Privacy Policy, Terms & Conditions, and Disclaimer.

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