Get Personal Injury Client Questionnaire - Tourkow, Crell, Rosenblatt ...

Filling out the Personal Injury Client Questionnaire is an essential step in initiating your personal injury case. This guide provides clear instructions to help you complete the questionnaire online with ease and confidence.

Follow the steps to successfully complete the questionnaire.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by entering your personal information. Fill in your full name, address, home phone number, cell phone number, email address, date of birth, social security number, marital status, and, if applicable, your spouse’s name.
3. Provide details about your employment by listing your employer's name, work phone number, job title, salary or wage rate, length of time with the employer, whether you work full or part-time, and any time lost due to the accident.
4. Fill in your insurance information, including your health and auto insurance coverage. Be sure to include the names of the insurance companies, the policyholder's name, contact information for the insurers, and any relevant claim numbers and adjuster’s details.
5. Detail the accident specifics. Include the date and time of the accident, the type of accident, and the location. Indicate your role during the accident (driver, passenger, pedestrian) and describe how many vehicles were involved and their respective lanes.
6. Describe the accident's details thoroughly. Explain what parts of the vehicle made impact, the nature of the impact, and provide notes regarding the initial impact. Document the weather conditions, whether seatbelts were used, the deployment of airbags, and the presence of cell phone usage during the incident.
7. In the property damage section, provide your vehicle's make, model, year, color, owner, and a detailed description of all damage to the vehicle, including whether it is still drivable and the amount of damage.
8. For medical information, list the treating physicians along with contact details and document any miscellaneous facilities you visited for treatment. Include injuries and complaints you experienced due to the accident.
9. Finally, complete the medical history section. This includes prior medical conditions, medications taken, details about previous auto accidents, any claims filed, slips and falls, worker’s compensation, and any prior serious injuries or treatments received.
10. Once you have completed all sections of the questionnaire, review your entries for accuracy. Save your changes, and you will have the option to download, print, or share the completed form as needed.

Start filling out your Personal Injury Client Questionnaire online today for a smoother claim process.