Personal Injury Checklist

*Note: If you’ve been the victim of an auto accident, truck accident or medical malpractice, link directly to the correlating checklist below. This will allow us to get the most detailed information possible. If not, please just scroll down and begin the checklist.

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

Have you been hurt or injured? YesNo

Did your injury occur in Pennsylvania? YesNo

Did your injury occur within the past two years? YesNo

Do you believe someone or something (other than yourself) was responsible for this injury? YesNo

How would you best describe how this injury occurred? Auto AccidentBicycle AccidentSlip & FallDog BiteDefective ProductNeglect or AbuseMedical MalpracticeWork Accident (includes Construction)Other

Please give a short description of how your accident and injury occurred:

Is there any kind of record of your accident or injury (e.g. police report, work citation, etc.)? YesNo

Did you receive medical treatment for your injury? YesNo

If yes, where?

Did you incur medical bills or expenses for this injury? YesNo

Did you incur any other costs or suffer any other financial damage - like loss of wages - because of this injury? YesNo

Do you have photos or video of your injury? YesNo

Do you believe you know what party is responsible for your accident and/or injury? YesNo

If yes, list the party's name and any contact information:

Were there any witnesses to your accident and/or injury? YesNo

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

Is there anything else we should know about your accident and/or injury?

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.