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FIND YOUR POLICE REPORT

Get Your Police Report Fast, Easy, and For Free! All We Need is a little information about the collision and some information on where we should send the report to.

Neck and Back

Do you have Neck or Back Pain?

Is your injury severe?

Severe Injuries include: Broken Bones; Muscle Tears; Daily Severe Pain; or Long Lasting Injuries

Please rate the severity of your pain.

“1“ = minor discomfort weekly; “3“ = minor pain weekly; “5“ = pain daily.

Other Parts of Body

Do you have pain in other parts of your body?

Is your injury severe?

Severe Injuries include: Broken Bones; Muscle Tears; Daily Severe Pain; or Long Lasting Injuries

Please rate the severity of your pain.

“1“ = minor discomfort weekly; “3“ = minor pain weekly; “5“ = pain daily.

Headaches, Numbness or Tingling

Do you have head aches or numbness and tingling?

Is your injury severe?

Severe Injuries include: Loss of Consciousness after crash; frequent headaches; severe numbness or paralysis.

How often do you have numbness or tingling?

“1“ = occasionally; “2“ = weekly; “3“ = daily.

Misc.

How much money from work have you lost as a result of this accident?

Did you pay any medical bills out of pocket? How Much?

If you have an attorney you will not have to pay any out of pocket expenses for medical treatment.

Are you married?

If you are married, you qualify for a special claim. Your attorney can explain in more detail.

Below is your estimated recovery. However, there can be no guarantee that this recovery is accurate without first speaking with an experienced attorney who can form a more complete evaluation of what your damages are and what a potential settlement would look like after hearing all facts and applicable evidence.

Total$

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