Get Negligence And Personal Injury Questionnaire

This guide provides clear and structured instructions for users looking to fill out the Negligence And Personal Injury Questionnaire online. By following these steps, you will be able to complete the form accurately and effectively, ensuring that all necessary information is provided.

Follow the steps to complete the questionnaire online.

1. Press the ‘Get Form’ button to access the Negligence And Personal Injury Questionnaire and open it in your preferred editing tool.
2. Begin by entering your personal information. Fill in your full name, address, and contact details, including home, work, and cell phone numbers.
3. Provide your birth date, Social Security Number, and Drivers License Number. Ensure accuracy as this information is critical.
4. In the section titled 'THE ACCIDENT', enter the date and time of the accident along with its location. Specify the owner's name and address of the property where the accident occurred.
5. Document the weather conditions at the time of the accident and describe how the accident happened. Include details about your actions right before the accident.
6. Reflect on preventive measures that could have been taken to avoid the accident and whether anything could have been done to mitigate its severity.
7. Indicate if you are aware of any previous complaints about the situation or location where the accident occurred.
8. In 'RESPONSE TO ACCIDENT', indicate whether you made any statements at the scene or after to police or insurance adjusters. Provide details if applicable.
9. Mention if the police were involved and whether you possess a copy of the police report. Record if any citations were issued or photographs taken.
10. Transition to the 'INJURIES' section by stating if you were injured and whether you received medical care, including any hospitals or doctors involved.
11. List any medications or medical supplies received after the accident, alongside any medical treatments and follow-up appointments.
12. Inquire about past medical issues and limitations, including any treatments for substance use or insurance denials due to health.
13. Under 'OTHER DAMAGES/MISCELLANEOUS', chronicle past personal injury claims and detail any work-related losses and limitations due to the accident.
14. Finally, provide information related to your insurance policies, including those of the other party, and indicate if you have a criminal record.
15. After completing all sections, thoroughly review the information provided for accuracy before saving your changes, downloading the form, and either printing or sharing it as needed.

Start filling out your Negligence And Personal Injury Questionnaire online today to ensure accurate representation of your circumstances.