Start Your Personal Injury Claim

What injuries did you receive?(Required)

Please select all that apply.

Whiplash (neck, shoulder, back)

Head & Brain Injury (e.g., concussion, skull fracture, traumatic brain injury)

Neck & Spinal Injury (e.g., spinal fracture, herniated disc, spinal cord damage)

Fractures & Dislocations (e.g., broken ribs, fractured limbs, dislocated joints)

Soft Tissue & Muscular Injury (e.g., torn ligaments, severe sprains or strains)

Internal Injuries (e.g., internal bleeding, organ damage)

Severe Cuts & Lacerations (e.g., deep wounds, permanent scarring)

Psychological Trauma (clinically diagnosed) (e.g., PTSD, severe anxiety/depression)

This field is hidden when viewing the form

When did the incident take place?(Required)

If you're not sure exactly, a rough date is fine.

DayDay12345678910111213141516171819202122232425262728293031

MonthMonth123456789101112

YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Did the negligence happen in the last 2.5 years?(Required)

Yes

No

Did the injury take place in England or Wales?(Required)

Yes

No

Have you suffered an injury, illness, or other physical harm as a result?(Required)

Yes

No

Have you previously instructed a solicitor about this issue?(Required)

Yes

No

This field is hidden when viewing the form

Are you currently declared bankrupt or in an IVA?

Yes

No

Please tick any evidence you currently have.

Select all that apply.

Medical records or discharge summaries

Complaint letters or correspondence with the hospital / practitioner

Photographs of injury or treatment area

Written statements or witness accounts

Reports or expert opinions

None of the above

Have you made a complaint to the practitioner?(Required)

Yes

No

Has the defendant accepted liability, or acknowledged their errors?(Required)

Yes

No