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Injury Claim Form

Claim form
1 - Tell us about your accident
Accident type: Incident Date: Basic description of your accident and injury: 2. CALL ME BACK
Fill in your details and contact information

Title: First name: Surname: Daytime phone number: Alternative daytime phone number: Email: Address: Town/City: Postal:
Please provide two phone numbers and your e-mail address-just in case we have difficulty contacting you.
We also need your full postal address to ensure all correspondence reaches you without delay.
We value your privacy. Your contact information will be treated with the strictest confidence.
3 - Choose a call-back time that suits you

When would you prefer to be called? :
Call-back times are Mon-Fri only and exclude public holidays.

Enter Sum for verification::
4 - Please check your contact details are correct

If you have had an accident, illness or injury, contact us - we will advise, and act for you at no cost to yourself.

What kinds of Accidents, Illnesses or Injuries can you claim for?

One of the many facts of life is that accidents happen. In the UK alone 2 million of the 10 million accidents that happen each year are down to someone else’s negligence. Most of the compensation claims in the UK are following Car or Motorcycle accidents, even though accidents can happen at any time, in any situation, often when we least expect it.

Click on any of the common examples below for more information on the types of injury we at Injuryclaimslawyers.com can help you make a personal injury compensation claim for:

Types of accidents we can help you claim for:

+ Car accidents
+ Motor cycle accidents
+ Taxi accidents
+ Slips, Trips and falls in a public place, shop or street
+ Train accidents
+ Forklift accidents
+ Scaffolding accidents
+ Accidents on holiday
+ Police induced injuries
+ Accidents in other peoples homes
+ Sports injuries
+ Fatal accidents

Types of illnesses we can help you claim for:

+ Asbestos related illness
+ Emphysema
+ Mesothelioma
+ Food poisoning
+ Medical and clinical negligence
+ Dental mistakes

Types of injuries we can help you claim for:

+ Whiplash injury
+ Slip, trip and fall injuries
+ Carpel tunnel syndrome
+ RSI (repetitive strain injuries)
+ Vibration/white finger
+ Tinnitus
+ Spinal cord injuries
+ Neck injury
+ Back injury
+ Soft tissue injuries
+ Head injury
+ Burn injuries
+ Shoulder injury

Remember, these are just some examples of injuries and illness’ that we deal with every day. Even if your injury is not listed above, do not hesitate to fill in the online claim form on the left hand side of this page or contact us directly on 08450533111 for more information and our commitment free legal advice.

www.injuryclaimslawyers.com is operated by ECS Limited and is regulated by the Ministry of Justice for regulated claims management activities.

Our authorisation number is CRM 16191 and our registration is recorded on the Ministry of Justice website.

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