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Truck Accidents Information Center

Truck Accidents Contact Form

*First Name

*Last Name

*Email Address

*Phone Number

*Zip

Street Address

Apt/Ste

Incident Street Address

Incident Apt/Ste

*Incident Zip

Were you or a loved one the victim of an accident involving a commercial truck?
YesNo

If the victim was a loved one, what is your relationship with that person?

When and where did the accident occur?

Were you or your loved one a passenger, driver, or pedestrian?
YesNo

How did the accident occur? Describe what happened.

What kind of truck was involved?

Do you know the name of the driver?
YesNo

His or her trucking company?
YesNo

His or her employer?
YesNo

Was a police report generated by the accident?
YesNo

Do you know if any traffic citations were issued?
YesNo

Do you know the names of any witnesses to the accident?
YesNo

What injuries were sustained as a result of the accident?

Did you seek and are you currently receiving medical treatment as a result of the accident?
YesNo

What is your prognosis?

Have you discussed this matter with your own insurance representative?
YesNo

Have you discussed this matter with any insurance representative or attorney representing other parties involved in the accident?
YesNo

How has this accident affected your overall quality of life and well-being?

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