AHH Intake Form

1

How were you hurt?* This field is required.

Car Accident

Truck Accident

Bicycle or Pedestrian Accident

Motorcycle Accident

Other Motor Vehicle Accident or Injury

2

How long ago was your accident?* This field is required.

In the last 14 days

Within 1-3 Months

Within 3-6 Months

Within 6-12 Months

More than 1 year ago

More than 2 years ago

3

Was the accident your fault?* This field is required.

YESNO

4

Did the police arrive?* This field is required.

Yes

No

I don't know

5

How were you or your passengers injured?* This field is required.

Fatality or Wrongful Death

Severe Injury: Dismemberment, Broken Bones, Fractures, Body Organ Injury, Concussion

Moderate Injury: Soft Tissue Neck and Back Pain or Whiplash

No Physical Injuries

6

Are you currently represented by an attorney for this accident?* This field is required.

No, I do not have an attorney

I have an attorney but I'm looking for someone else to represent my case

Yes, I have an attorney

I have already settled my case

7

Are you currently seeing a doctor for this accident?* This field is required.

No, I have not seen a doctor

I have a doctor but I'm looking for a different doctor to look over my injuries

Yes, I have seen a doctor

8

Was there damage to your vehicle during this accident?* This field is required.

YESNO

9

Please Describe Your Accident and Injuries:

10

Your Name

First Name

Last Name

11

Your Email Address* This field is required.

example@example.com

12

Your Phone Number* This field is required.

13

Do you agree to be contacted by a legal professional?* This field is required.*By clicking this link, you agree to be contacted by a legal professional. You acknowledge and consent that a representative may reach out to you by phone, text, or email, using the contact information you provide, even if your number is on a Do Not Call list. This contact may be for the purpose of providing a legal consultation, evaluation, or further information. Your consent is not a condition of purchase or legal representation. Standard message and data rates may apply.

YESNO

14

BY CLICKING SUBMIT YOU HAVE AGREED TO ALL TERMS BELOW

ACCEPTANCE OF TERMS
Welcome to AccidentHelpHotline.org (“Website”). By accessing or using our Website, you agree to adhere to and be bound by these Terms of Service (“ToS”). If you do not agree with these terms, kindly refrain from using this Website.

DESCRIPTION OF SERVICES
AccidentHelpHotline.org provides a marketing platform for lawyers and law firms. We offer landing pages for various legal practice areas, including but not limited to car accidents, personal injury, green card applications, and more. We collect lead information from visitors and facilitate connections with our partner lawyers to provide legal services.

USER RESPONSIBILITIES
You commit to using the Website only for lawful purposes and in a manner consistent with all applicable laws and regulations. Submission of lead information requires accurate and complete details. Additionally, you agree not to engage in activities that may compromise the security or integrity of the Website or its users.

DISCLAIMER OF LIABILITY
AccidentHelpHotline.org provides a platform to connect potential clients with partner lawyers. We do not endorse, guarantee, or take responsibility for the quality, accuracy, or legality of the legal services provided by partner lawyers. Any interactions or transactions between users and partner lawyers are solely between those parties.

PRIVACY POLICY
Your use of the Website is also subject to our Privacy Policy, available at AccidentHelpHotline.org. By using the Website, you consent to the collection, use, and sharing of your information as described in the Privacy Policy.

INTELLECTUAL PROPERTY
All content on the Website, including text, graphics, logos, images, and software, is the property of AccidentHelpHotline.org or its licensors and is protected by intellectual property laws. Reproduction, distribution, modification, or creation of derivative works based on our content is prohibited without explicit permission.

TERMINATION
We reserve the right to terminate or suspend your access to the Website at any time, without notice, for any reason, including a violation of these Terms of Service.

CHANGES TO TERMS
AccidentHelpHotline.org reserves the right to modify these Terms of Service at any time. Your continued use of the Website after changes are posted constitutes your acceptance of the revised terms.

GOVERNING LAW
These Terms of Service are governed by and constructed in accordance with the laws of the State of Texas, without regard to its conflict of law principles.

ARBITRATION AGREEMENT AND CLASS ACTION WAIVER

EFFECTIVE UPON CLICKING
By clicking this link and/or accessing any services, products, content, or materials offered through it ("Services"), you ("User") agree to be bound by the following Arbitration Agreement. This agreement governs any dispute between you and AccidentHelpHotline.org, including its affiliates, officers, employees, agents, licensors, and any third parties involved in providing or supporting the Services.

BINDING ARBITRATION
Any dispute, claim, or controversy arising out of or relating to your access to, use of, or interaction with the Services—including any issue concerning the interpretation, scope, or enforceability of this Arbitration Agreement—shall be resolved exclusively through final and binding arbitration, and not in court, before a single arbitrator.

GOVERNING LAW AND VENUE
This Arbitration Agreement shall be governed by the Federal Arbitration Act and, to the extent not preempted, the laws of the State of Texas, without regard to conflicts of law principles. Arbitration shall be conducted in Dallas, Texas, unless both parties agree otherwise in writing.

MANDATORY AND MUTUAL APPLICATION
This agreement to arbitrate applies equally to both parties. By continuing beyond this point, both you and AccidentHelpHotline.org waive the right to a trial by jury or to participate in any class or collective action, including in court or arbitration.

SCOPE; THIRD-PARTY BENEFICIARIES
This Arbitration Agreement applies to all disputes involving third parties that interact with, deliver, or are otherwise involved with the Services. Such third parties shall be considered intended third-party beneficiaries of this Arbitration Agreement and may enforce its terms to the same extent as if they were original parties.

NO CLASS OR REPRESENTATIVE ACTIONS
All arbitrations shall be conducted on an individual basis only. You and AccidentHelpHotline.org agree that no class, consolidated, or representative actions shall be permitted, whether in arbitration or otherwise. The arbitrator shall have no authority to combine or aggregate claims or preside over any form of representative or class proceeding.

SEVERABILITY
If any part of this Arbitration Agreement is found to be invalid or unenforceable, that portion shall be severed, and the remainder shall remain in full force and effect.
By clicking this link and accessing the Services, you acknowledge and agree that you have read, understood, and consented to this Arbitration Agreement, and that it is binding upon you and AccidentHelpHotline.org.