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Personal Injury Questionnaire

Name *

Email *

Phone *

No spaces

Have you had an accident in the last 3 years that wasn’t your fault and as a result of which you sustained an injury? *

Yes

No

Have you made a claim previously for this accident? *

Yes

No

If you selected 'Yes' above, what was the outcome?

Do you wish to pursue a claim for your injuries sustained in the accident, which may give rise to some form of compensation for you? *

Yes

No

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Myers Lister Price is a partnership registered in England and Wales. Our office is located at: 7 Market St, Altrincham, Cheshire. WA14 1QE. Tel: 0161 9269969 Fax: 0161 9261500 DX: 29911 Altrincham 2. VAT number 510148005. A list of Partners is available for inspection at the registered office.

Our service is provided by solicitors of England and Wales and regulated by the Solicitors Regulation Authority. The Authority's rules can be accessed via their website - www.sra.org.uk. Authorised and regulated by the Financial Services Authority.

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