Get 21258 - Questionnaire.qxd

Completing the 21258 - Questionnaire.qxd is an essential step in your appointment process with our experts. This guide will assist you in filling out the form efficiently and accurately.

Follow the steps to successfully complete the questionnaire online.

1. Click ‘Get Form’ button to access the questionnaire and open it in your preferred online editor.
2. Provide your relationship to the injured person if you are filling out the form on their behalf. Options include parent, guardian, friend, or other, with a space to specify.
3. Fill in the personal details of the injured person, including their name, date of birth, address, and telephone number for both home and work.
4. Answer questions regarding the background of the injured person, including hand dominance, marital status, whether they have children, occupation, and special skills.
5. Detail the specifics of the injury, including the date and time of the incident. Describe briefly how the injury occurred and what part of the body was affected.
6. Indicate the type of injury by selecting from options like road traffic accident, injury at work, tripping/slipping, or other, and provide additional details if necessary.
7. If applicable, answer questions specific to road traffic accidents, including your position in the vehicle and details on the vehicle that was involved.
8. List all injuries or symptoms sustained from the accident, providing as much detail as possible.
9. Complete questions regarding any hospitalization after the injury, including treatments received, medications prescribed, and follow-up actions required.
10. Indicate whether you attended your GP for treatment after the injury, providing details of visits and current treatment status.
11. Fill out the section regarding any previous injuries or claims related to similar incidents.
12. Complete the physical build section with your height and weight.
13. Sign and date the form, confirming that the information provided is true.
14. Once all fields are completed, save your changes, download, print, or share the form as needed.

Start filling out your form online today to ensure a smooth appointment process.