Can I Claim Compensation?

1. Please describe the type of accident? Please Select Road accident Work accident Slip trip or fall Accident abroad Industrial disease Medical accident Assaulted at Work Criminal accident Faulty product Itchy sofa Other

2. Were you injured in the last 3 years? Please Select Yes No

3. Did you receive medical treatment for your injuries? Please Select Yes No

4. How long did you suffer from your injuries? Please Select Days Weeks Months Still Suffering No Injuries

5. Please describe the type of injury? Please Select Head Eye Face Neck Shoulder Back Arm Wrist Hand Hip Leg Knee Ankle Foot Internal Organ

6. Was the accident your fault? Please Select Yes No

7. Were there any witnesses? Please Select Yes No

8. Have you previously taken legal advice about claiming compensation? Please Select Yes No

9. First Name

10. Surname

11. Email

Once you have completed all the questions please click the "Can I Claim?" button
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