Injury Questionnaire in Fresno, CA

 
 
 
 
 
 
 
What type of incident were you involved in?
 
 
 
Where did the accident occur?
 
 
 
What date did the accident occur?
 
 
 
Were you injured?
 
 
 
Medical Care Providers
 
 
 
Did the police respond to the scene?
 
 
 
Was a police report prepared?
 
 
 
What City did the accident occur in?
 
 
 
Who is your insurance company?
 
 
 
Who is the insurance company for the other party involved?
 
 
 
If you were involved in a Car Collision, do you have Damage Photos?
 
 
 
If you were involved in a Slip & Fall - What did you slip on?
 
 
 
If there anything else you believe is important to tell us?