David Resnick & Associates, PC

Serving the metropolitan New York area and beyond.
450 7th Avenue, Suite 409 | New York, NY 10123
New York, NY New York City, NYC
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Auto Accidents Evaluation Form

CONTACT INFORMATION
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ACCIDENT INFORMATION
Date of Accident:

Time of Accident:

City where Accident occurred:

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Location of Accident?

Do you have copy of police report? Yes No

Is an attorney currently representing you for this matter? Yes No

How did accident occur?:

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Do injuries Prevent Working? Yes No

If yes, when did you stop working:

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SERVING: The Bronx - Brooklyn - Manhattan - Queens - Staten Island
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450 7th Avenue, Suite 409
New York, NY 10123