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Select the type of accident
  • - select accident type -
  • Rideshare (Uber, Lyft, etc.)
  • Car
  • Pedestrian
  • Bicycle
  • Motorcycle
  • Commercial Truck
  • E-Bike or E-Scooter
Select the date of your injury.
Where in California did the incident occur?
Select the type of treatment received?
  • - select type -
  • Hospitalized
  • Emergency Room / Urgent Care
  • Saw Doctor or Specialist
  • No treatment was received
  • N/A Incident resulted in death
What is the status of your medical treatment:
  • - select status -
  • I need to start treating
  • I’m treating
  • I’m done treating
Please describe the specific facts of how the accident occurred and details of your injuries that will help us determine if you qualify for compensation.
Please upload any relevant documents and/or photographs.
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