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Name*
Sex

Did law enforcement show up at the scene?*
Did you sustain any injuries / discomfort whatsoever?*

Were you the*
If you were the passenger, do you have your own auto insurance?*

If you were the driver, were you at fault?*
Did you seek any medical treatment?*

Have you retained an attorney for compensation?*
Do we have your permission to have a local PI attorney contact you for a no cost or obligation call?*

Are you open to receiving quotes for auto / health / life / home insurance?*
I am interested in
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Accident Records is a Referral Service and Lead Generation for Paid Physician or Attorneys Subscribers as well as assisting users in retrieving their personal Accident Report.