(503) 474-2736 • E-mail: info@andersonlawcenter.com
426 N.E. Third Street • P.O. Box 1498 • McMinnville, OR 97128

Accident Report
 

 		 

Have you experienced an accident?

Do you have questions about an accident you may have experienced? Take a moment to fill out the information below and click the button at the bottom of the page. What you write below is confidential, and will not be disclosed by Thomas H. Anderson, P.C. to any person without your consent. What you disclose may qualify as a lawyer-client communication, and be privileged under ORS 40.225. The lawyer-client privilege is most valuable and the protection strongest when clients refrain from discussing their case with anyone but their lawyer. Discussion of the facts with a third party may constitute a waiver of the lawyer-client privilege.

Last name
 First name
 M. I.
Your name (if you are responding for someone else)
Street address
City
 State
 Zip
Day phone
 Evening phone
Fax
 E-mail
Age
 Were you injured?
Yes   
No   
When did it happen?
Location of accident (street, city, state)
Is there a police report?
Yes   
No   
If auto accident, do you have insurance?
Yes   
No   
If auto accident, is other party insured?
Yes   
No   
What was the damage to your property?
 Do you have photographs of the property damage?
Yes   
No   
Did you go to the doctor?
Yes   
No   
Did you go to the hospital?
Yes   
No   
What injuries do you have?
Do you presently have an attorney on this case?
Yes   
No   
Have you ever had an attorney on this case?
Yes   
No   
Are you still being treated by a doctor?
Yes   
No   
How much time have you lost from work?
Please describe what happened
(100 word maximum)
What additional information would you like us to know?
(100 word maximum)
Do you have a question about an Oregon accident?
(100 word maximum)
Would you like Thomas H. Anderson, P.C. to call you to discuss your case free of charge?
Yes   
No   

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