Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by indicating if you are filing for yourself or for someone else. If filing for another person, enter your name and relationship to the claimant.
3. Provide claimant information, including their last name, first name, address, email, phone number, and other required identifiers such as social security number and date of birth.
4. Detail the incident information, including the date, time, and location of the incident. Make sure to provide a detailed description of what happened, including specifics about the circumstances, injuries, and damages.
5. If applicable, fill in the witness section, indicating whether police responded to the incident and providing details about any witnesses.
6. Include hospital information if the claimant was transported to a medical facility. This includes the hospital name and treatment start date.
7. If involved in a vehicle-related incident, complete the sections related to vehicle and driver information, including any additional insurance details.
8. Attach any necessary documents, such as photos, police reports, medical records, and other relevant materials that can support your claim.
9. Summarize your claimed expenses, including medical expenses and lost wages, providing a total amount claimed.
10. Finally, review the completed form for accuracy. When satisfied, save the changes, download, or print the form for submission as needed.

Take the next step and complete your NY Personal Injury Claim Form online today.