Health Survey

The discovery of your recent health and medical condition will improve our treatment.

Our Privacy Policy

Please Select All That Apply

The Police were called and came to the scene of the accident.

I have a Police Accident Report.

Was a ticket issued related to the accident?

I went to a hospital after the accident.

I have records from the hospital.

Insurance Company has been contacted.

Claim with the Insurance Company is still open.

Claim with the Insurance Company has been Settled.

Insurance company has paid for car repairs.

Have you received treatment for injuries sustained from this accident?

Medical Doctor

Chiropractor

Physical Therapist

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