Automobile Injury Incident Form

If you are injured in an automobile accident, it is important that your attorney have all the information about the accident in order to represent you as best as possible in court. Keeping a form like this one in your glove compartment is a good way to make sure you get all the information necessary...

If you are injured in an automobile accident, it is important that your attorney have all the information about the accident in order to represent you as best as possible in court. Keeping a form like this one in your glove compartment is a good way to make sure you get all the information necessary for a good auto accident case.

AUTOMOBILE INJURY INCIDENT FORM–(print and keep in vehicle with your insurance information)

***Do Not Rely on Police to Obtain This Information***

Click Here for a Printable Version

Date of Incident: Time of Incident:

Location of Incident:

(street/roadway)

(city)

At-Fault Driver/Party Information (use back of page for additional parties):

Name:

Address:

Phone number:

Height: Weight: Hair color: Date of Birth:

At-Fault Driver/Party Insurance Information:

Insurance Company:

Address:

Phone number:

Policy number:

Name of Insured:

At-Fault Driver/Party Vehicle Information:

Make: Model: Licence Plate:

Location and extent of any damage:

Witness Information (use back of form for additional witnesses):

Name:

Address:

Phone number:

How Did the Incident Occur?:

Prepared and published by:

Diana K. Zilko, Esq.

In Association with the Law Offices of Stout & Zilko

418 S. Brea Blvd.

Brea, CA 92821

714-256-1200

[email protected]

The content of this article is provided for informational purposes only. If you need legal assistance with an Auto Accident case, consult with Diana Zilko, or an Auto Accident Lawyer near you to discuss the details of your case.

Talk to a Personal Injury Lawyer

Need a lawyer? Start here.

How it Works

  1. Briefly tell us about your case
  2. Provide your contact information
  3. Choose attorneys to contact you
Make the Most of Your Claim

Get the compensation you deserve.

We've helped 285 clients find attorneys today.

How It Works

  1. Briefly tell us about your case
  2. Provide your contact information
  3. Choose attorneys to contact you