We know that many of our clients would prefer to complete a form online rather than speak to us on the phone. Don’t worry, we are happy to accommodate our clients in anyway they prefer.Why don’t you complete are Compensation Questionnaire today and find our if you are eligible for compensation following your accident at work.

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ABOUT YOUR ACCIDENT

INJURY

Have you had to take time off work as a result of the accident? Yes.No

Are you still off work as a result of your injury? Yes.No

Did you seek any medical attention as a result of the accident? Yes.No

Please tick whether you have seen your GP and/or went to hospital? GP.Hospital

Did you have to stay overnight? Yes.No

FINANCIAL LOSS

Have you lost any income/wages as a result of the accident? Yes.No

Have you suffered any other financial losses as a result of your accident? Yes.No

THANK YOU FOR COMPLETING OUR NO WIN NO FEE QUESTIONNAIRE - WE INTEND TO GIVE YOU A DECISION WITHIN THE HOUR. PLEASE LET US KNOW HOW TO CONTACT YOU.

I consent to Rebecca & Alec contacting me.
I would like to be contacted by email.telephone.