Auto Accident Checklist

Let's find out if you have a viable personal injury case for your auto accident. Answer these questions to the best of your ability.

When did your auto accident occur?

Where did your auto accident occur?

Did you get the information of the other driver(s) involved in the accident? YesNo

If yes, please list the driver’s name and contact information here:

Did you get the license plate(s) of the other vehicle(s) involved in the accident? YesNo

If yes, please list license plate number and state here:

Did you get information from any additional witnesses to the accident? YesNo

If yes, please list witness names and contact information here:

After your accident, were you able to contact the police? YesNo

Did the police file an accident report? YesNoI don't know

Do you have a copy of the accident report? YesNo

Did you take pictures of the vehicles involved in the accident? YesNo

Did you sustain injuries from the accident? YesNo

Were you taken to the hospital after the accident? YesNo

Did you see a doctor regarding injuries sustained from the accident? YesNo

Please give a short description of your injuries and how you were treated:

Have you been following the medical advice given to you for your injuries? YesNo

Was your vehicle damaged in the accident? YesNo

Do you have an estimate of how much these damages will be to fix? YesNo

If yes, what is the estimate (in U.S. dollars):

Your Information:

Thanks for submitting your checklist. We’ll be in touch very soon. If you have any questions or you’d like to talk to us right now, call (570) 348-3711.