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What type of accident were you involved in?

Personal Injury

Auto Accident

Work Accident

Sexual Harassment

Medical Malpractice

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Were you the driver, passenger or pedestrian?

Driver

Passenger

Pedestrian

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What kind of vehicle were you in?

Uber, Lyft, Taxi

Motorcycle

Bicycle

Commercial / Truck

Car

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Did you received any medical treatment after the accident?

Emergency Room

Ambulance

Doctors Office

No Treatment

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Who's fault was the accident?




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Did you received any medical treatment?

Emergency Room

Ambulance

Doctors Office

No Treatment

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Were you physically injured while working?

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Were you sexually harassed at work?

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Who was it that harassed you?




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How recent was this?





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How recent was your accident?





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