If you are one of the 4 million people a year in  the UK who suffers an injury in an accident, or you have been the victim of a medical mistake you can now find out for free whether it is worth trying to pursue a claim and just how to go about it by filling out the simple form  below.

If you have been injured in an accident within the last three years let us have the details and we will ask one of our panel solicitors who cover the whole North West of England, to let you have a free assessment of whether it is worth your  while trying to make a claim, what it may be worth, how to go about it and the options for funding any such action. There is no obligation to take the advice given or to use the solicitors who have given the advice. Simply fill in the details below and click submit.

If you have any problems or would just like to ask us a question then simply phone or email  us.

Accident Claim Assessment Form

The Boring Bit

Your First Name
Your Last  Name
Address
Post Code
Email  address
Home telephone
Work Telephone (if available)
When is the best time to contact you by telephone?	Morning Afternoon Evening  or  Please do not contact me by telephone
Is this on your  home or work number	Home Work
How would you  prefer to be contacted	Telephone Email Letter
Any other  instructions about contacting you?

About the Accident

When did the accident occur?
Where did the  accident occur?
Please describe  what happened?
Were you injured? If so please provide details of your injury
Were there any witnesses to the accident?	Yes No
Do you have  their contact details?	Yes No
Have you or your insurers already instructed solicitors to act for you ?	Yes No
Is there any other information which you think may be relevant?

How did you  hear about EzeeClaim4U? (not compulsory, but would be helpful)

Please make a Selection Internet Search Leaflet / Press Advert Recommendation from Friend / Relative Other

If you are happy with the  information you have provided click the Submit button and we will try and have your case assessed within 2 days and get back to you within this time limit.

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