{"id":809,"date":"2026-05-23T14:30:24","date_gmt":"2026-05-23T14:30:24","guid":{"rendered":"https:\/\/amgpreview.com\/dllawgroup\/?page_id=809"},"modified":"2026-05-26T20:24:12","modified_gmt":"2026-05-26T20:24:12","slug":"personal-injury-contact-form","status":"publish","type":"page","link":"https:\/\/amgpreview.com\/dllawgroup\/personal-injury-contact-form\/","title":{"rendered":"Personal Injury Contact Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"809\" class=\"elementor elementor-809\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c28a559 e-flex e-con-boxed e-con e-parent\" data-id=\"c28a559\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8c790ec elementor-widget elementor-widget-text-editor\" data-id=\"8c790ec\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><strong class=\"m-font-size-14\">catastrophic injury and wrongful death claims<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dd7f3df elementor-widget elementor-widget-heading\" data-id=\"dd7f3df\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Get in Touch<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6a81b95 elementor-widget elementor-widget-text-editor\" data-id=\"6a81b95\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p class=\"text-align-center\">Every day in California, people are injured in accidents that may give rise to a personal injury or wrongful death claim. By filling out this form, you\u2019re helping our team quickly understand what happened and whether a consultation is the right next step for you.<\/p><p class=\"text-align-center\">Our attorneys will review your information and reach out to discuss your options. The more detail you provide, the faster we can evaluate your case and connect you with a lawyer who can help. There\u2019s no cost, no obligation, and it only takes a minute.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-8f553a7 e-flex e-con-boxed e-con e-parent\" data-id=\"8f553a7\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-90d7d5a e-con-full e-flex e-con e-child\" data-id=\"90d7d5a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-bd4d328 elementor-widget elementor-widget-shortcode\" data-id=\"bd4d328\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_2' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Personal Injury Intake Form<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/dllawgroup\/wp-json\/wp\/v2\/pages\/809' data-formid='2' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_1'>\n                            \n                            <span id='input_2_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_2_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_1.3' id='input_2_1_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_2_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_2_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_1.6' id='input_2_1_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_2_3\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_3'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_2_3' type='tel' value='' class='large full'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_4\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_4'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_2_4' type='email' value='' class='large full'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_2_5\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_5'>Would you like to receive SMS notifications from DL Law Group?<\/label><div class='ginput_container ginput_container_select'><select name='input_5' id='input_2_5' class='large gfield_select'     aria-invalid=\"false\" ><option value='Yes, I would like to receive text messages to the phone number provided as frequent as applicable in order to manage my case (Text message and data rates may apply). You can reply STOP or UNSUBSCRIBE to opt out at any time.' >Yes, I would like to receive text messages to the phone number provided as frequent as applicable in order to manage my case (Text message and data rates may apply). You can reply STOP or UNSUBSCRIBE to opt out at any time.<\/option><option value='No' >No<\/option><\/select><\/div><\/div><fieldset id=\"field_2_9\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_2col gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What type of incident were you involved in?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_9'><div class='gchoice gchoice_2_9_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.1' type='checkbox'  value='Motor vehicle accident'  id='choice_2_9_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_9_1' id='label_2_9_1' class='gform-field-label gform-field-label--type-inline'>Motor vehicle accident<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_9_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.2' type='checkbox'  value='Slip and fall'  id='choice_2_9_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_9_2' id='label_2_9_2' class='gform-field-label gform-field-label--type-inline'>Slip and fall<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_9_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.3' type='checkbox'  value='Dog bite or animal attack'  id='choice_2_9_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_9_3' id='label_2_9_3' class='gform-field-label gform-field-label--type-inline'>Dog bite or animal attack<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_9_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.4' type='checkbox'  value='Wrongful death'  id='choice_2_9_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_9_4' id='label_2_9_4' class='gform-field-label gform-field-label--type-inline'>Wrongful death<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_9_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.5' type='checkbox'  value='Other\/not sure'  id='choice_2_9_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_9_5' id='label_2_9_5' class='gform-field-label gform-field-label--type-inline'>Other\/not sure<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_10\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_10'>Please describe what happened:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_10' id='input_2_10' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_2_18\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >How recent was your accident?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_18'><div class='gchoice gchoice_2_18_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.1' type='checkbox'  value='In the last 14 days'  id='choice_2_18_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_18_1' id='label_2_18_1' class='gform-field-label gform-field-label--type-inline'>In the last 14 days<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_18_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.2' type='checkbox'  value='2 weeks to 3 months'  id='choice_2_18_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_18_2' id='label_2_18_2' class='gform-field-label gform-field-label--type-inline'>2 weeks to 3 months<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_18_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.3' type='checkbox'  value='3 to 6 months'  id='choice_2_18_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_18_3' id='label_2_18_3' class='gform-field-label gform-field-label--type-inline'>3 to 6 months<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_18_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.4' type='checkbox'  value='6 to 12 months'  id='choice_2_18_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_18_4' id='label_2_18_4' class='gform-field-label gform-field-label--type-inline'>6 to 12 months<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_18_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.5' type='checkbox'  value='1 to 2 years'  id='choice_2_18_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_18_5' id='label_2_18_5' class='gform-field-label gform-field-label--type-inline'>1 to 2 years<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_18_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.6' type='checkbox'  value='More than 2 years'  id='choice_2_18_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_18_6' id='label_2_18_6' class='gform-field-label gform-field-label--type-inline'>More than 2 years<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_19\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_3col gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Who do you believe was at fault?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_19'><div class='gchoice gchoice_2_19_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.1' type='checkbox'  value='Another person or party'  id='choice_2_19_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_19_1' id='label_2_19_1' class='gform-field-label gform-field-label--type-inline'>Another person or party<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_19_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.2' type='checkbox'  value='Myself'  id='choice_2_19_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_19_2' id='label_2_19_2' class='gform-field-label gform-field-label--type-inline'>Myself<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_19_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.3' type='checkbox'  value='Not sure'  id='choice_2_19_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_19_3' id='label_2_19_3' class='gform-field-label gform-field-label--type-inline'>Not sure<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_20\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What kind of injuries did you suffer? Check all that apply<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_20'><div class='gchoice gchoice_2_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Head \/ brain injury \/ concission'  id='choice_2_20_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_20_1' id='label_2_20_1' class='gform-field-label gform-field-label--type-inline'>Head \/ brain injury \/ concission<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_20_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.2' type='checkbox'  value='Upper back injury'  id='choice_2_20_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_20_2' id='label_2_20_2' class='gform-field-label gform-field-label--type-inline'>Upper back injury<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_20_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.3' type='checkbox'  value='Lower back injury'  id='choice_2_20_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_20_3' id='label_2_20_3' class='gform-field-label gform-field-label--type-inline'>Lower back injury<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_20_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.4' type='checkbox'  value='Broken bones'  id='choice_2_20_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_20_4' id='label_2_20_4' class='gform-field-label gform-field-label--type-inline'>Broken bones<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_20_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.5' type='checkbox'  value='Internal injuries'  id='choice_2_20_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_20_5' id='label_2_20_5' class='gform-field-label gform-field-label--type-inline'>Internal injuries<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_20_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.6' type='checkbox'  value='Burn'  id='choice_2_20_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_20_6' id='label_2_20_6' class='gform-field-label gform-field-label--type-inline'>Burn<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_20_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.7' type='checkbox'  value='Neck injury'  id='choice_2_20_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_20_7' id='label_2_20_7' class='gform-field-label gform-field-label--type-inline'>Neck injury<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_20_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.8' type='checkbox'  value='Injury to extremities (arms, shoulder, legs)'  id='choice_2_20_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_20_8' id='label_2_20_8' class='gform-field-label 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cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_2_21\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What type of medical treatment did you receive?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_21'><div class='gchoice gchoice_2_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='Ambulance'  id='choice_2_21_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_1' id='label_2_21_1' class='gform-field-label gform-field-label--type-inline'>Ambulance<\/label>\n\t\t\t\t\t\t\t<\/div><div 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