Accident in illinois
How did you get hurt? Car Accident18 Wheeler AccidentMotorcycle AccidentWork AccidentDog Bite / Animal AttackSlip and FallPedestrian AccidentBicycle/Scooter AccidentNone of These
When did the accident happen?
Was the accident your fault? YesNo
Were you physically hurt? YesNo
Did your injury require immediate medical attention? YesNo
Did the accident cause hospitalization or medical treatment? YesNo
Estimated Medical Bills: None$1-$10000$10000-$25000$25000-$50000$50000-$100000$100000-Above
Is an attorney helping you with this claim? YesNo
Where did the accident happen? —Please choose an option—Adams CountyAlexander CountyBond CountyBoone CountyBrown CountyBureau CountyCalhoun CountyCarroll CountyCass CountyChampaign CountyChristian CountyClark CountyClay CountyClinton CountyColes CountyCook CountyCrawford CountyCumberland CountyDeKalb CountyDeWitt CountyDouglas CountyDuPage CountyEdgar CountyEdwards CountyEffingham CountyFayette CountyFord CountyFranklin CountyFulton CountyGallatin CountyGreene CountyGrundy CountyHamilton CountyHancock CountyHardin CountyHenderson CountyHenry CountyIroquois CountyJackson CountyJasper CountyJefferson CountyJersey CountyJo Daviess CountyJohnson CountyKane CountyKankakee CountyKendall CountyKnox CountyLake CountyLaSalle CountyLawrence CountyLee CountyLivingston CountyLogan CountyMacon CountyMacoupin CountyMadison CountyMarion CountyMarshall CountyMason CountyMassac CountyMcDonough CountyMcHenry CountyMcLean CountyMenard CountyMercer CountyMonroe CountyMontgomery CountyMorgan CountyMoultrie CountyOgle CountyPeoria CountyPerry CountyPiatt CountyPike CountyPope CountyPulaski CountyPutnam CountyRandolph CountyRichland CountyRock Island CountySt Clair CountySaline CountySangamon CountySchuyler CountyScott CountyShelby CountyStark CountyStephenson CountyTazewell CountyUnion CountyVermilion CountyWabash CountyWarren CountyWashington CountyWayne CountyWhite CountyWhiteside CountyWill CountyWilliamson CountyWinnebago CountyWoodford County
Please describe what happened:
First Name:
Last Name:
Phone Number:
Zip Code:
Email:
