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Client Questionnaire (Personal Injury) Name: Date: How did you hear about Irvin & Terrazzo, P.C.? Type of Case (circle): MVA Premises Liability Labor Law Product Liability Other: Please answer the

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How to fill out client questionnaire personal injury

How to fill out a client questionnaire for personal injury?

01

Begin by providing your personal information.

1.1

Start by entering your full name, contact information, and address.

1.2

Include any alternative contact details, such as an email address or a secondary phone number.

02

Describe the incident.

2.1

Clearly state the date, time, and location of the accident or injury.

2.2

Provide a detailed account of how the incident occurred, including any contributing factors or parties involved.

03

Explain the extent of your injuries.

3.1

Describe the injuries you sustained as a result of the incident.

3.2

Include any immediate medical attention you received and ongoing treatments or therapies you are undergoing.

04

Document any witnesses.

4.1

If there were any witnesses present during the incident, list their names and contact information.

4.2

Witnesses can provide valuable statements or testimonies to support your case.

05

Include information about the negligent party.

5.1

If another individual or entity was responsible for your injury, provide their name, address, and contact details.

5.2

If you are unsure about the identity of the negligent party, mention any potential individuals or entities involved.

06

Outline any previous medical history relevant to your injuries.

6.1

Mention any pre-existing conditions that may have been aggravated or affected by the incident.

6.2

Include details about any prior accidents or injuries that could impact your current case.

07

Provide information regarding insurance coverage.

7.1

List all the insurance providers involved, including your own and any other parties related to the incident.

7.2

Include policy numbers and contact information for these insurance companies.

Who needs a client questionnaire for personal injury?

A client questionnaire for personal injury is needed by individuals who have sustained injuries as a result of an accident or incident. This questionnaire helps collect vital information about the incident, injuries, witnesses, and other parties involved. It is typically required by personal injury lawyers or insurance companies when evaluating a claim or building a case for compensation. This form ensures that all the necessary details are properly documented to support the individual's case.

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What is client questionnaire personal injury?

Client questionnaire personal injury is a document used to gather information about a person's personal injury claim.

Who is required to file client questionnaire personal injury?

An individual who has suffered a personal injury and is pursuing a legal claim is required to file the client questionnaire personal injury.

How to fill out client questionnaire personal injury?

The client questionnaire personal injury can be filled out by providing detailed information about the personal injury, medical treatment received, and any other relevant details.

What is the purpose of client questionnaire personal injury?

The purpose of client questionnaire personal injury is to provide the necessary information for legal representation to assess and pursue a personal injury claim.

What information must be reported on client questionnaire personal injury?

Information such as details of the personal injury, medical treatment received, impact on daily life, and any other relevant information related to the injury.

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