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Type of Accident

Accident Date

Zip Code

Was the accident your fault, or were you issued a ticket for the accident?

Yes No

Was a police report filed?

Yes No

Were you physically injured or in pain?

Yes No

Does anyone involved have vehicle insurance coverage?

Yes No

What types of injuries were sustained?

Whiplash Bone fracture Limb loss Spinal cord injury or paralysis Brain injury Loss of life

Is an attorney helping you with your claim or has an attorney already rejected your claim?

Yes No

Name

Phone

Email

Contact us

1500 nw 89th ct Miami FL 33172

305-600-3030

accident911help@gmail.com

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