Please use the information I have supplied to contact me regading this enquiry.
Yes pleaseNo thanks
All questions must be answered in order to progress your claim.
How did you hear about KG Solicitors Limited Search EngineSocial MediaAdvertisementFriend
Please select which one applies MrMrsMissMsL/F
Still off work YesNo
Did you go to the GP YesNoN/A
Did you attend Hospital YesNoN/A
Did you stay over night YesNoN/A
Any physiotherapy recommended by the doctor YesNoN/A
Are you in hire YesNoN/A
Do you need a hire vehicle YesNoN/A
What were the weather conditions SunnyRainingSnowIceFogOther
What were the road conditions DryWetSnowIceMudOilOther
Was the incident reported to the police YesNo
If selected yes,
Do you have Legal Expenses Insurance cover already (If Yes please provide a copy.) YesNo
Do you authorise us to contact other organisation to obtain further information if necessary? YesNo
Please note all questions above must be answered before we can submit a claim for personal injury.
I hereby declare that these details have been supplied by the above name person in section A.
The information supplied above is correct and complete to the best of my knowledge and belief.