Motor Vehicle Accident Questionnaire

Thank you for filling out this questionnaire. In order to determine if we can be of service to you, it will be useful for you to answer a few specific questions. At the end of the questionnaire, hit the SUBMIT button.

If you prefer you may fill the form, print it and fax to us at (206) 374-7377
Or, you may print the form, scan it, and email it to: klf@krafchick.com
Most find filling it out and hitting the SUBMIT button to be easiest.

Click here for the printable version.




Accident Facts:


What type of collision did you have:

Did police come to the scene?
If yes, do you have a copy of the police report?
Emergency medical or fire personel at the scene?

Before you left the scene of the collision (check all that apply)




Did you or anyone else take photographs of the scene or the vehicles?

How did you leave the scene of the collision?






Have you or anyone else in your vehicle missed work because of injuries suffered
from the collision?

Do you have an insurance policy that covers you for this collision?

Does the person who hit you have insurance?

At-fault party


Have you talked to the person that caused the collision?

Anything else you would like to tell us about the collision and its effects on you or others in your vehicle?

Legal information contained in this site should not be construed to be formal legal advice, nor should the "contact us" information be interpreted as establishing an attorney-client relationship. Rest assured, any information you provide will not be shared outside of our practice.

Case results will vary, based on the facts of each individual case. Krafchick Law Firm does not offer a guarantee of positive case results. All potential clients are urged to make an independent evaluation of any personal injury lawyer under consideration.

We urge potential clients to review our website, our experience and credentials.