Get Motor Vehicle Collision/personal Injury Questionnaire

Completing the motor vehicle collision/personal injury questionnaire is an important step in documenting your experience and ensuring that all relevant details are recorded. This guide provides clear, step-by-step instructions to help you fill out the form accurately and efficiently online.

Follow the steps to complete your questionnaire online.

1. Click the ‘Get Form’ button to access the questionnaire and open it in the online editor.
2. Begin by entering your name and phone number in the designated fields. Ensure that your contact information is accurate for follow-up purposes.
3. Describe the collision in detail in your own words. This section allows you to provide a personal account of what happened, which is important for context.
4. Indicate the location of the collision by specifying the city or town and state in which it occurred.
5. Fill in the date and time of the collision. Be precise, marking whether it's AM or PM.
6. Select your role in the incident by choosing whether you were the driver, passenger, or pedestrian.
7. If you were a passenger, specify your seating position in the vehicle. This information can help clarify the dynamics of the accident.
8. Provide the make and model of the vehicle you were in, followed by the make and model of the other vehicle involved in the collision.
9. Answer the questions regarding vehicle contact. Indicate whether your vehicle struck the other vehicle or was struck by it.
10. Describe the nature of the impact by specifying the point of impact relative to your vehicle.
11. Report the approximate speeds of both vehicles at the time of the collision. Estimate as accurately as possible.
12. Indicate the weather conditions at the time of the accident by selecting the appropriate option.
13. Answer how your vehicle was positioned at the time of the collision. Select relevant options such as 'park,' 'moving,' or 'stopped.'
14. State whether your brakes were applied during the incident.
15. Indicate whether your vehicle was displaced by the impact and in what direction.
16. Describe any potential injuries by answering the questions about your head and body positioning during the incident.
17. Report any damage to your vehicle, both externally and internally, by selecting the appropriate options.
18. Clearly specify any points of pain or injury experienced at the time of or after the incident.
19. Indicate your consciousness status immediately after the accident, and if applicable, the duration of unconsciousness.
20. Provide information on whether you received medical attention after the accident and any treatments received.
21. Answer additional health-related questions, including previous similar problems and information on any medications or medical supplies provided.
22. Describe your work situation and how the injury has affected it, including details about any lost workdays.
23. Complete the insurance section by providing details of your personal injury insurance coverage, the at-fault insurance company, and your attorney's information.
24. Once you have filled out all sections, review your information for accuracy. You can then save your changes, download the completed form, print it, or share it as needed.

Start completing your MOTOR VEHICLE COLLISION/PERSONAL INJURY QUESTIONNAIRE online today for accurate documentation and better support.