Peterson Law Offices: More Details

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Phone number(s) with area code*

E-mail Address*

Good time to call

Address

Date of the accident*

What state did the accident occur in? (OR and WA only)*

Who was injured

What state does the person who was injured live in?

What are the injuries?

What part of the body was injured?

Is the person who was injured in pain now?

Have you given a statement to the insurance company?

Yes
No

Was the person who was injured being paid to work at the moment the accident happened?

Yes
No

What kind of treatment has the person who was injured received?

Please type your question or describe how the accident happened

For car, truck & motorcycle accidents:

Was the injured person a passenger or a driver?

Passenger
Driver

If they were a driver, were they insured at the time of the accident?

Yes
No

Has the person who was injured given a statement to the other insurance company?

Yes
No

Has it been more than 7 days since the last medical visit?

Yes
No

How much damage was done to the vehicle?

What part of the vehicle was hit?

About what speed was the impact?

What kind of vehicles were in the accident?

Do you know if there were any witnesses to the accident?

Yes
No

Was any one cited?

Yes
No

Has a DMV report been filed?

Yes
No

Was there a police report?

Yes
No

For dog bites:

Does the person who was bitten have any visible scars?

Yes
No

If so, has a doctor decided that the scar is permanent?

Yes
No

Did the person who was injured have a follow up treatment?

Yes
No

Do you know who the owner of the dog is?

Yes
No

Do you have insurance information from the owner of the dog?

Yes
No

For pedestrian accidents:

Was there a traffic signal?

Yes
No

Was the injured person at a crosswalk?

Yes
No

Was the injured person more than half way across when they got hit?

Yes
No

What was the person who was injured hit by?

Name

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More Details

For car, truck & motorcycle accidents:

For dog bites:

For pedestrian accidents:

Licensed in OR & WA

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