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Briefly describe the accident.
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What was the cause of the accident?
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Where did the accident occur?
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What was the date, time, and weather conditions?
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Please identify any witnesses.
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What were your injuries?
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Have you seen a Doctor?
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Name of Doctor/Hospital.
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Was an accident report filled out?
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Has the insurance company called you?
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Have you given any statements?
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Do you have hospitalization insurance?
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Name of insurance company, if known.
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Are you presently represented by an attorney?
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Who is responsible for your injury?
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