Accident/Injury Assessment Form

Wards are a firm of regional South West solicitors, with offices specialising in personal injury claims. All cases are handled by solicitors who are Law Society Personal Injury Panellists and approved by them, due to our experience, the volumes of similar cases we handle and our quality control procedures.

Wards offer a free initial interview of 30 minutes on all accident/injury claims. This can be in person if you are local to one of our offices, or by telephone.

Please ensure you complete all fields

Thank you for completing our Accident Assessment Form. Your details are listed below as a reminder (you can copy and paste them into a document and save them or print the page as a record).

A solicitor will contact you within one working day to discuss the possible next step you can take. In the meantime, if you have any queries, please contact Janet Rimmer on 01275 858 515.

Accident Details

• Accident Type : <%=strAccidentType%>
• Accident Type if Other : <%=strOther%>
• Description : <%=strDescription%>
• Accident Date : <%=strDay & "/" & strMonth & "/" & strYear%>
• Location : <%=strLocation%>
• Responsible : <%=strResponsible%>
• Instructed : <%=strInstructed%>
• Title : <%=strTitle%>
• Forename : <%=strForename%>
• Surname : <%=strSurname%>
• Address : <%=strAddress%>
• Town : <%=strTown%>
• County : <%=strCounty%>
• Postcode : <%=strPostcode%>
• Telephone : <%=strTelephone%>
• e-mail : <%=strEMail%>
• DOB : <%=strDOB%>
• Branch : <%=strBranch%>
• Marketing : <%=strMarketing%>

Wards homepage <% End Sub Sub ValidateForm If strAccidentType <> "" Then bPartial = True Else bComplete = False End If If strDescription <> "" Then bPartial = True Else bComplete = False End If If strDay <> "Day" AND strDay <> "" Then bPartial = True Else bComplete = False bDate = False End If If strMonth <> "Month" AND strMonth <> "" Then bPartial = True Else bComplete = False bDate = False End If If strYear <> "Year" AND strYear <> "" Then bPartial = True Else bComplete = False bDate = False End If If bDate Then dtAccident = DateSerial(Cint(strYear), Cint(strMonth), Cint(strDay)) End If If strLocation <> "" Then bPartial = True Else bComplete = False End If If strResponsible <> "" Then bPartial = True Else bComplete = False End If If strInstructed <> "" Then bPartial = True Else bComplete = False End If If strTitle <> "Title" AND strTitle <> "" Then bPartial = True Else bComplete = False End If If strForename <> "" Then bPartial = True Else bComplete = False End If If strSurname <> "" Then bPartial = True Else bComplete = False End If If strAddress <> "" Then bPartial = True Else bComplete = False End If If strTown <> "" Then bPartial = True Else bComplete = False End If If strCounty <> "" Then bPartial = True Else bComplete = False End If If strPostcode <> "" Then bPartial = True Else bComplete = False End If If strTelephone <> "" Then bPartial = True Else bComplete = False End If If strEMail <> "" Then bPartial = True Else bComplete = False End If If strDOB <> "" Then bPartial = True Else bComplete = False End If End Sub Sub ListErrors If strAccidentType = "" Then Response.Write("Please select an accident type.
") End If If strAccidentType = "Other" AND strOther = "" Then Response.Write("Please enter an accident type.
") End If If strDescription = "" Then Response.Write("Please enter an accident description.
") End If If bDate Then If DatePart("d", dtAccident) <> Cint(strDay) OR DatePart("m", dtAccident) <> Cint(strMonth) Then Response.Write("Please enter a valid date.
") End If Else Response.Write("Please enter a valid date.
") End If If strLocation = "" Then Response.Write("Please enter an accident location.
") End If If strResponsible = "" Then Response.Write("Please say who you think was responsible.
") End If If strInstructed = "" Then Response.Write("Please say whether you have previously instruced a solicitor.
") End If If strTitle = "" OR strTitle = "Title" Then Response.Write("Please select a title.
") End If If strForename = "" Then Response.Write("Please enter your forename.
") End If If strSurname = "" Then Response.Write("Please enter your surname.
") End If If strAddress = "" Then Response.Write("Please enter your address.
") End If If strTown = "" Then Response.Write("Please enter your town.
") End If If strCounty = "" Then Response.Write("Please enter your county.
") End If If strPostcode = "" Then Response.Write("Please enter your postcode.
") End If If strTelephone = "" Then Response.Write("Please enter your telephone number.
") End If If strDOB = "" Then Response.Write("Please enter your Date of Birth.
") End If If strEMail = "" Then Response.Write("Please enter your e-mail address.
") End If End Sub 'Sub MailDetails ' Dim strBody, strEOL, Mailer ' strEOL = Chr(13) & Chr(10) ' Set Mailer = Server.CreateObject("CDONTS.NewMail") ' Mailer.From = "Accident@wards.uk.com" ' Mailer.To = "Alison.Underhill@wards.uk.com;Helen.Gough@wards.uk.com;Janet.Rimmer@wards.uk.com;Larry.Rawlinson@wards.uk.com" ' Mailer.Subject = "Accident Details" ' strBody = strBody & "Accident Type : " & strAccidentType & strEOL ' strBody = strBody & "Accident Type if Other : " & strOther & strEOL ' strBody = strBody & "Description : " & strDescription & strEOL ' strBody = strBody & "Accident Date : " & strDay & "/" & strMonth & "/" & strYear & strEOL ' strBody = strBody & "Location : " & strLocation & strEOL ' strBody = strBody & "Responsible : " & strResponsible & strEOL ' strBody = strBody & "Instructed : " & strInstructed & strEOL ' strBody = strBody & "Title : " & strTitle & strEOL ' strBody = strBody & "Forename : " & strForename & strEOL ' strBody = strBody & "Surname : " & strSurname & strEOL ' strBody = strBody & "Address : " & strAddress & strEOL ' strBody = strBody & "Town : " & strTown & strEOL ' strBody = strBody & "County : " & strCounty & strEOL ' strBody = strBody & "Postcode : " & strPostcode & strEOL ' strBody = strBody & "Telephone : " & strTelephone & strEOL ' strBody = strBody & "e-mail : " & strEMail & strEOL ' strBody = strBody & "DOB : " & strDOB & strEOL ' strBody = strBody & "Branch : " & strBranch & strEOL ' strBody = strBody & "Marketing : " & strMarketing & strEOL ' Mailer.Body = strBody ' Mailer.Send ' Set Mailer = nothing 'End Sub %> <% Dim strAccidentType, strOther, strDescription, strDay, strMonth, strYear, strLocation, strResponsible, strInstructed, strTitle Dim strForename, strSurname, strAddress, strTown, strCounty, strPostcode, strTelephone, strEMail, strBranch, strDOB, strMarketing Dim bPartial, bComplete, bDate, dtAccident strDay = "0" strMonth = "0" strYear = "0" strAccidentType=Request("AccidentType") strOther=Request("Other") strDescription=Request("Description") strDay=Request("Day") strMonth=Request("Month") strYear=Request("Year") strLocation=Request("Location") strResponsible=Request("Responsible") strInstructed=Request("Instructed") strTitle=Request("Title") strForename=Request("Forename") strSurname=Request("Surname") strAddress=Request("Address") strTown=Request("Town") strCounty=Request("County") strPostcode=UCase(Request("Postcode")) strTelephone=Request("Telephone") strEMail=Request("EMail") strDOB=Request("DOB") strBranch=Request("Branch") strMarketing=Request("Marketing") bPartial = False bComplete = True bDate = True ValidateForm If bComplete Then ' MailDetails DisplayResults Else DisplayForm End If %>