Please describe the type of accident * |
|
|
When were you injured? * |
|
|
Did you receive medical treatment for your injuries * |
|
|
How long did you suffer from your injuries * |
|
|
Please describe the type of injury
(select all relevant) *
|
|
|
Was the accident your fault? * |
|
|
Were there any witnesses? * |
|
|
|
|
|
Please provide a brief description of how you received your injuries (up to 500 characters) * |
|
|
|
|
|
Have you previously taken legal advice about claiming compensation * |
|
|