/* growform client2 bundle.url: https://assets.growform.co/96896150-mmawu6km/form.bundle.js resolve.source: kv resolve.at: 2026-03-11T11:27:29.416Z form.source: api cache.age_ms: 0 kv.value_present: true fallback_used: false */ ;(function () { var EMBED_TYPE = "iFrame"; var FORM_ID = "69418b36780268bbe5113e43"; var FORM_BUNDLE_URL = "https://assets.growform.co/96896150-mmawu6km/form.bundle.js"; // injected by worker (KV/memory/fallback) var FORM_DATA = {"data":{"form":{"_id":"69418b36780268bbe5113e43","options":{"numberOfSteps":5,"dateFormat":"DD/MM/YYYY","progressBar":{"enable":true},"continueButton":{"continueText":"Next","submitText":"Send my report","backText":"Back"},"customStyles":{"width":{"unit":"px","value":580},"parentContainerMinHeight":{"value":0,"unit":"px"},"parentBackgroundImage":{"imageInitialHeight":1362,"imageInitialWidth":2066,"imageHeight":1362,"imageWidth":2066,"imageUrl":"https://res.cloudinary.com/dqnjggegp/image/upload/v1597337140/uploads/qmsfk98ank3wfp1ehvyg.jpg"},"headerMarginTop":40,"parentBackgroundColor":"#ffffff","innerFormBackgroundColor":"#ffffff","innerFormBackgroundTransparency":"","primaryColor":"#065bb5","bodyTextColor":"#343434","parentContainerBackgroundType":"color","innerFormBackgroundType":"none","buttonBorderColor":"#ff7500","buttonColorSelected":"#ffa659","buttonBorderColorSelected":"#ff7500","footerMarginBottom":70,"errorColor":"#ff4e4e","buttonColor":"#ff7500","buttonTextColor":"#ffffff","inputLabelColor":"#a3a3a3","inputTextColor":"#000000","defaultFont":"Montserrat","sq_buttonFont":"Poppins","sq_buttonFontSize":15,"showShadows":"Yes","sq_buttonTextColor":"#343434","sq_buttonColor":"#FFFFFF","sq_buttonColorSelected":"#FFFFFF","sq_buttonBorderColor":"#DADADA","sq_buttonBorderColorSelected":"primary","sq_buttonBannerColor":"#FFFFFF","rt_buttonFont":"Montserrat","rt_buttonFontSize":15,"rt_buttonColor":"#FFFFFF","rt_buttonColorSelected":"#FFFFFF","rt_buttonTextColor":"#343434","rt_buttonBorderColor":"#DADADA","rt_buttonBorderColorSelected":"primary","inputLabelFont":"Montserrat","inputFontSize":16,"continueSubmitButtonFontSize":15,"fullModeBackgroundColor":"#EEE6F8","canvasSetup":"minimal","progressColor":"#fde307"},"localization":{"dateFormat":"MM/DD/YYYY"},"exportTransparentBackground":false,"customScript":"","customRedirectUrls":[{"url":""}],"logo":{"value":"https://res.cloudinary.com/dqnjggegp/image/upload/v1731406309/uploads/gvhpg8xs2pdismbzuere.webp","linkUrl":"https://www.example.com","imageWidth":100,"imageHeight":6,"imageInitialWidth":1160,"imageInitialHeight":75}},"fields":{"Decorative Header_52363373085874":{"type":"Decorative Header","value":"Thanks for your inquiry!","width":12,"step":"complete","sortOrder":1,"fieldStyle":{"fontSize":{"value":17,"unit":"px"},"fontWeight":"Normal"},"margins":{"marginTop":10},"stepId":"complete"},"Decorative Header_576559560634956":{"type":"Decorative Header","value":"How shall we get in touch about your claim?","width":12,"step":5,"sortOrder":1,"fieldStyle":{"fontSize":{"value":17,"unit":"px"},"fontWeight":"Normal"},"stepId":"ff4727c9498ef9c0a6c989d9"},"email_907058157108782":{"type":"Email","label":"Your email address","width":12,"margins":{"marginBottom":0},"step":5,"sortOrder":3,"stepId":"ff4727c9498ef9c0a6c989d9"},"phone_589083232390193":{"type":"Phone","label":"Your phone number","width":12,"margins":{"marginBottom":0},"step":5,"sortOrder":4,"helperText":"","stepId":"ff4727c9498ef9c0a6c989d9"},"text_373461752242760":{"type":"Text","label":"Your name","width":12,"margins":{"marginBottom":0},"step":5,"sortOrder":2,"validationRules":{"required":true},"stepId":"ff4727c9498ef9c0a6c989d9"},"Decorative_Paragraph_194067845817258":{"type":"Decorative Paragraph","value":"Thanks for getting in touch. We'll be in touch about your case in the next working day.","width":12,"step":"complete","sortOrder":2,"margins":{"marginBottom":60},"stepId":"complete"},"buttons_782408809089103":{"type":"Buttons","validationRules":{"required":false},"label":"Accident type","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Car accident","image":null,"id":"b414dcd0e47e6855c791d9fc"},{"text":"Addicent at work","image":null,"id":"5e73250c48028f299c8c0d44"},{"text":"Other / not listed","image":null,"id":"187126df42290fa0cf0ad5a2"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","rt_width":27},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"4","sq_buttonsPerRowMobile":"2"},"stepId":"ac0ce1d8634334328d03ff33"},"decorative_header_892646863007116":{"type":"Decorative Header","value":"How long ago did it happen?","width":12,"step":2,"sortOrder":1,"fieldStyle":{"fontSize":{"value":17,"unit":"px"},"fontWeight":"Normal"},"stepId":"60c2d61a66a74bcb70ce6e49","margins":{"marginBottom":5}},"buttons_88398974892131":{"type":"Buttons","validationRules":{"required":false},"label":"Accident timeframe","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"options":[{"text":"Less than 3 months ago","id":"874d51264d39eae103abb124","image":null},{"text":"3 - 6 months ago","id":"17300563d9567a00f68b979e","image":null},{"text":"6 - 12 months ago","id":"01b3f3dfdc886023c8fa07cc","image":null},{"text":"12+ months ago","image":null,"id":"738fcafe864903a2d37e30eb"}],"stepId":"60c2d61a66a74bcb70ce6e49","sortOrder":2,"hideLabel":true,"imageStyles":{"rt_width":27}},"decorative_header_503429670737739":{"type":"Decorative Header","value":"What type of personal injury do you have?","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":17,"unit":"px"},"fontWeight":"Normal"},"stepId":"ac0ce1d8634334328d03ff33","margins":{"marginBottom":5},"location":null},"decorative_header_14021764636003":{"type":"Decorative Header","value":"Select all that apply","width":12,"sortOrder":2,"stepId":"66e3c3c17a3e2346f92b931a","fieldStyle":{"fontSize":{"value":17,"unit":"px"},"fontWeight":"Normal"}},"buttons_573184712849318":{"type":"Buttons","validationRules":{"required":false},"label":"Practice Areas","width":12,"multiple":true,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"options":[{"text":"Personal Injury","id":"131f641bcee6d57824604460"},{"text":"Social Security Disability","image":null,"id":"2e7d63cbcbdc8d56babca836"},{"text":"MN Workers' Compensation","image":null,"id":"84f526322481ca2418dec939"},{"text":"Long-Term Disability","image":null,"id":"9848ecfa45cd0c1a5079d7c5"},{"text":"I'm Not Sure","image":null,"id":"0945b05b465120e95a6ccd64"}],"stepId":"66e3c3c17a3e2346f92b931a","sortOrder":3,"hideLabel":true,"helperText":""},"decorative_header_854471348750423":{"type":"Decorative Header","value":"What kind of legal help are you looking for?","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":19,"unit":"px"},"fontWeight":"Bold"},"stepId":"66e3c3c17a3e2346f92b931a","margins":{"marginBottom":5},"location":null},"decorative_header_180358992323029":{"type":"Decorative Header","value":"

What is the date of your denial

","width":12,"v":2,"sortOrder":1,"stepId":"be995f6d1f6a1fafb8ad284b"},"text_899363868972889":{"type":"Text","label":"Date of denial","width":12,"sortOrder":2,"stepId":"be995f6d1f6a1fafb8ad284b"},"address_876249996258908":{"type":"Address","label":"What is your address?","width":12,"stepId":"ff4727c9498ef9c0a6c989d9","sortOrder":5},"zipcode_667857812240452":{"type":"Zipcode","label":"What is your zip code?","zipcodeFieldFormat":"zipcode_usa","width":12,"stepId":"ff4727c9498ef9c0a6c989d9","sortOrder":6},"decorative_header_104451735455576":{"type":"Decorative Header","value":"

Have you applied for disability benefits?

","width":12,"v":2,"sortOrder":1,"stepId":"788f50b00d9a2478421db953"},"buttons_223737682330365":{"type":"Buttons","validationRules":{"required":false},"label":"Have you applied for disability benefits?","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"Yes","id":"ee62de28a02f787eac6edcce"},{"text":"No","id":"4843c301a1c2b92ee530c678"}],"stepId":"788f50b00d9a2478421db953","sortOrder":2},"decorative_header_752276311298272":{"type":"Decorative Header","value":"

Have you received a denial?

","width":12,"v":2,"sortOrder":1,"stepId":"f33bbf82325d883f2742e618"},"buttons_411193533872505":{"type":"Buttons","validationRules":{"required":false},"label":"Have you received a denial?","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"Yes","id":"ee62de28a02f787eac6edcce"},{"text":"No","id":"4843c301a1c2b92ee530c678"}],"stepId":"f33bbf82325d883f2742e618","sortOrder":2},"decorative_header_113740776762010":{"type":"Decorative Header","value":"

Tell us more about your claim, including your disabling conditions.

","width":12,"v":2,"sortOrder":1,"stepId":"9dd32898c714ffa30574c5b5"},"text_941550542259403":{"type":"Text","label":"Tell us more about your claim, including your disabling conditions.","width":12,"sortOrder":2,"stepId":"9dd32898c714ffa30574c5b5"},"decorative_header_158252883299213":{"type":"Decorative Header","value":"

Are you currently working?

","width":12,"v":2,"sortOrder":1,"stepId":"85c2cebbfad5302f4a05ff80"},"buttons_602462612354027":{"type":"Buttons","validationRules":{"required":false},"label":"Are you currently working?","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"Yes, full-time","id":"ee62de28a02f787eac6edcce"},{"text":"Yes, part-time","id":"4843c301a1c2b92ee530c678"},{"text":"No","id":"2c871ca155f1d038102c845a"}],"stepId":"85c2cebbfad5302f4a05ff80","sortOrder":2},"decorative_header_469132561266071":{"type":"Decorative Header","value":"

Is there anything else we should know?

","width":12,"v":2,"sortOrder":1,"stepId":"cd43e80134ffbfd4ad3ff6f8"},"text_224135161174568":{"type":"Text","label":"Is there anything else we should know?","width":12,"sortOrder":2,"stepId":"cd43e80134ffbfd4ad3ff6f8"},"decorative_header_723306473170643":{"type":"Decorative Header","value":"Where did the injury occur?","width":12,"step":2,"sortOrder":1,"fieldStyle":{"fontSize":{"value":17,"unit":"px"},"fontWeight":"Normal"},"stepId":"58809bbc4e19d8ed5015e487","margins":{"marginBottom":5}},"buttons_108002087279307":{"type":"Buttons","validationRules":{"required":false},"label":"Where did the injury occur?","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"options":[{"text":"North Dakota","id":"874d51264d39eae103abb124","image":null},{"text":"Minnesota","id":"17300563d9567a00f68b979e","image":null},{"text":"Other","id":"01b3f3dfdc886023c8fa07cc","image":null}],"stepId":"58809bbc4e19d8ed5015e487","sortOrder":2,"hideLabel":true,"imageStyles":{"rt_width":27}},"decorative_header_865243087025964":{"type":"Decorative Header","value":"What is the current status of your claim?","width":12,"step":2,"sortOrder":1,"fieldStyle":{"fontSize":{"value":17,"unit":"px"},"fontWeight":"Normal"},"stepId":"2649f9945a41f5b21f1646ae","margins":{"marginBottom":5}},"text_43721301927558":{"type":"Text","label":"What is the current status of your claim?","width":12,"stepId":"2649f9945a41f5b21f1646ae","sortOrder":2},"decorative_header_751827829111744":{"type":"Decorative Header","value":"

Date of injury:

","width":12,"v":2,"sortOrder":1,"stepId":"b33315e5e47f56f8632ad1f5"},"text_430883600326549":{"type":"Text","label":"Date of injury","width":12,"sortOrder":2,"stepId":"b33315e5e47f56f8632ad1f5"},"decorative_header_774728332474674":{"type":"Decorative Header","value":"

Do you have an active claim?

","width":12,"v":2,"sortOrder":1,"stepId":"ba6cd889acb268cd1904eee1"},"buttons_358103634045783":{"type":"Buttons","validationRules":{"required":false},"label":"Do you have an active claim?","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"Yes","id":"ee62de28a02f787eac6edcce"},{"text":"No","id":"4843c301a1c2b92ee530c678"}],"stepId":"ba6cd889acb268cd1904eee1","sortOrder":2},"decorative_header_529446654084067":{"type":"Decorative Header","value":"

Status of Claim:

","width":12,"v":2,"sortOrder":1,"stepId":"f6751771c4383e19a9956d96"},"text_324513157651691":{"type":"Text","label":"Status of Claim","width":12,"stepId":"f6751771c4383e19a9956d96","sortOrder":2}},"ownedByUser":"685adce2950e6b000bb4e428","formName":"Injury & Disability Intake Form","personalisation":{"form_related_to":"Law firm"},"created":"2025-12-16T16:39:18.887Z","steps":[{"id":"66e3c3c17a3e2346f92b931a","name":"Claim detail","sortOrder":1},{"id":"ac0ce1d8634334328d03ff33","name":"Accident type","sortOrder":2,"copyOf":"8d53a2591d86a402dbecf0d3","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"131f641bcee6d57824604460"}]}]}},{"id":"60c2d61a66a74bcb70ce6e49","name":"Timeline details","sortOrder":3,"copyOf":"acd45227cac332d443c4e1db","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"131f641bcee6d57824604460"}]}]}},{"id":"58809bbc4e19d8ed5015e487","name":"Where did the injury occur?","sortOrder":4,"copyOf":"60c2d61a66a74bcb70ce6e49","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"131f641bcee6d57824604460"}]}]}},{"id":"2649f9945a41f5b21f1646ae","name":"What is the current status of your claim?","sortOrder":5,"copyOf":"58809bbc4e19d8ed5015e487","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"131f641bcee6d57824604460"}]}]}},{"id":"788f50b00d9a2478421db953","name":"Have you applied for social security benefits?","sortOrder":6,"copyOf":"be995f6d1f6a1fafb8ad284b","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"2e7d63cbcbdc8d56babca836"}]}]}},{"id":"f33bbf82325d883f2742e618","name":"Have you received a denial?","sortOrder":7,"copyOf":"be995f6d1f6a1fafb8ad284b","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_223737682330365","operator":"selected_option","criteria":"ee62de28a02f787eac6edcce"}]},{"sortOrder":2,"rules":[{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"2e7d63cbcbdc8d56babca836"}]}]}},{"id":"be995f6d1f6a1fafb8ad284b","name":"Date of Denial","sortOrder":8,"conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_411193533872505","operator":"selected_option","criteria":"ee62de28a02f787eac6edcce"}]},{"sortOrder":2,"rules":[{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"2e7d63cbcbdc8d56babca836"}]}]}},{"id":"85c2cebbfad5302f4a05ff80","name":"Are you currently working?","sortOrder":9,"copyOf":"c47fec4e15bc3ca95980a601","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"2e7d63cbcbdc8d56babca836"}]},{"sortOrder":2,"rules":[{"observedField":"buttons_411193533872505","operator":"selected_option","criteria":"4843c301a1c2b92ee530c678"}]}]}},{"id":"9dd32898c714ffa30574c5b5","name":"Tell us more about your claim","sortOrder":10,"copyOf":"be995f6d1f6a1fafb8ad284b","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_411193533872505","operator":"selected_option","criteria":"4843c301a1c2b92ee530c678"},{"observedField":"buttons_602462612354027","operator":"not_selected_option","criteria":"2c871ca155f1d038102c845a"}]},{"sortOrder":2,"rules":[{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"2e7d63cbcbdc8d56babca836"}]}]}},{"id":"b33315e5e47f56f8632ad1f5","name":"Date of injury","sortOrder":11,"copyOf":"cd43e80134ffbfd4ad3ff6f8","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":2,"rules":[{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"84f526322481ca2418dec939"}]}]}},{"id":"ba6cd889acb268cd1904eee1","name":"Do you have an active claim?","sortOrder":12,"copyOf":"b33315e5e47f56f8632ad1f5","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":2,"rules":[{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"84f526322481ca2418dec939"}]}]}},{"id":"f6751771c4383e19a9956d96","name":"Status of Claim","sortOrder":13,"copyOf":"ba6cd889acb268cd1904eee1","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":2,"rules":[{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"84f526322481ca2418dec939"}]}]}},{"id":"cd43e80134ffbfd4ad3ff6f8","name":"Is there anything else we should know?","sortOrder":14,"copyOf":"9dd32898c714ffa30574c5b5","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":2,"rules":[{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"2e7d63cbcbdc8d56babca836"},{"observedField":"buttons_573184712849318","operator":"not_selected_option","criteria":"131f641bcee6d57824604460"},{"observedField":"buttons_573184712849318","operator":"selected_option","criteria":"84f526322481ca2418dec939"}]}]}},{"id":"ff4727c9498ef9c0a6c989d9","name":"Contact info","sortOrder":15}],"folderId":"69418b05780268bbe5113dd1","screenshotUrl":"https://res.cloudinary.com/dqnjggegp/image/upload/v1772124435/growform-production/form-screenshots/69418b36780268bbe5113e43.png","isActive":true,"reportedSpam":null,"__v":0,"lastEdited":"2026-02-26T21:35:03.960Z","spamOcr":"What kind of legal help are you looking for?\nSelect all that apply\n☐ Personal Injury\nMN Workers'\nCompensation\n☐ I'm Not Sure\nNEXT\n☐ Social Security Disability\n☐ Long-Term Disability What kind of legal help are you looking for ? Select all that apply ☐ Personal Injury MN Workers ' Compensation ☐ I'm Not Sure NEXT ☐ Social Security Disability ☐ Long - Term Disability","leadsCount":3},"accountIsActive":true,"accountIsFreeTrial":false}}; // ---- Utils ---- function safeJSONStringify(obj) { return JSON.stringify(obj) .replace(/<\/(script|style)/gi, '<\\/$1') .replace(//g, '--\\>') .replace(/\u2028/g, '\\u2028') .replace(/\u2029/g, '\\u2029'); } function preloadScript(href) { try { if (!href) return; if (document.querySelector('link[rel="preload"][href="' + href + '"]')) return; var l = document.createElement("link"); l.rel = "preload"; l.as = "script"; l.href = href; l.crossOrigin = ""; // allow cache reuse in iframe document.head.appendChild(l); } catch (_) {} } function parseQuery() { var out = {}; try { if (!window.location.search) return out; var usp = new URLSearchParams(window.location.search); usp.forEach(function (v, k) { out[k] = v; }); } catch (_) {} return out; } function buildIframeHTML(opts) { var html = '\n' + '\n' + '\n' + ' \n' + ' \n' + ' \n' + '\n' + '\n' + ' \n' + '
\n' + '