Personal Injury Claims

Road Traffic Accident Questionnaire

Unsure if you can make a claim for your road accident? Find out here for FREE.

Simply fill in the questionnaire below and click submit.

The information will automatically be sent to one of our specialist Personal Injury Solicitors who assess your claim and contact you as soon as possible.

The information you provide is confidential and will not be passed to any third parties. You will not be obliged to instruct us by using this free service

1. The date of your accident

2. Please describe, briefly, how the accident happened (include details like: were you stationary or moving, if so how fast, were you at a junction or open road)

3. Were you a driver or passenger?
driver
passenger

4. Were you wearing a seat belt?
yes
no

5. Were you wearing a properly adjusted head restraint?
yes
no

6. What is the name and address of the party you consider responsible for this accident? (if not known, please state 'not known')

7. Why do you think they were to blame?

8. What were the driving conditions like? (was it night or day, fine, raining, foggy, icy, etc.)

9. Please describe any conversation that you had with the other party or driver as appropriate following the accident.

10. Your name

11. Your address

12. Your phone number (required)

13. Your Work Number (optional)

14. Your Mobile Number (optional)

15. Your E-mail address