Name: Sweeney Merrigan Personal Injury Lawyers
Rating: 4.9 (113 reviews)

Where and when did the incident occur?
Please provide a brief description of the incident.
Did the police respond to the accident? If yes, do you have a copy of the police report?
Had you consumed any alcohol, drugs, or prescription medication in the 24 hours prior to the incident? If so, please state what you consumed, the quantity you consumed, and when you consumed it.
Were you transported from the scene of the incident by ambulance?
Did you go to the hospital/urgent care? If yes, please specify the name of the hospital/urgent care.
Please provide the name of each doctor and/or hospital you have treated with to date for your injuries.
Please provide a description of all injuries you sustained from the incident.
Did you miss time from work because of your injuries? Please answer "Yes" or "No".
If "Yes", please provide the following: Your employers name and your title; number of days missed; your salary/hourly wage; and whether you have received a doctors note excusing you from work:
Please provide your health insurance information, including name of health insurance provider and policy number.

Please upload any photos of your injuries above.
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Max. file size: 50 MB.
Please upload any photos of your injuries above.
Please upload any photos of the scene of the accident above.
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Max. file size: 50 MB.
Please upload any photos of the scene of the accident above.
Please upload any Medical Records relating to the incident above.
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Max. file size: 50 MB.
Please upload any Medical Records relating to the incident above.
Please upload any and all Investigative, Incident, and/or Accident Reports above.
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Max. file size: 50 MB.
Please upload any and all Investigative, Incident, and/or Accident Reports above.
Email
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Premises Liability Accident Onboarding Form