Personal Injury Consultation Full Name*Date of birth Date Format: MM slash DD slash YYYY Address*Marital Status*Occupation*Clients employer’s name and addressVAT RegisteredPPS No.Mobile No.*Home Phone Number*Work Number*E-mail address*Any Past Injuries*Any Previous Claims*Any Previous Award*Location of vehiclePlace and date of accidentTime of accident : HH MM AM PM Conditions at time of accidentClaimant wearing seatbeltClaimant seating positionInvestigating Garda name and addressIncomeCopy P60s/AccountsAuthority re Medical Records/social welfare paymentsEngineers Report of LocusWitnessesClient’s Vehicle MakeVehicle RegInsurance CompanyPolicy No.Third Party Vehicle MakeRegInsurance companyPolicy No.Medical TreatmentClient’s Medical AttendantClient’s Physiotherapist Practice Areas Family Law Conveyancing & Property Probate Wills Trusts & Estate Planning Elder Law Personal Injury Medical Negligence Employment Law Judicial Review Military Law Litigation Criminal Law
