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Personal Injury Compensation Claim Form

If you would like to talk to us about making a personal injury claim please fill out the form below. One of our specialists will phone you back.

Please note that by completing this form you are making a preliminary enquiry only. We will not be able to pursue a claim for you until we have spoken with you and confirmed we are able to help.

Your Details

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Accident / Incident details
Date of accident / incident:

There are time limits that apply to when you must bring a claim for personal injury. If your accident happened more than 2 years ago or, if you are suffering with a disease which was diagnosed more than 2 years ago, please tick here

Further information on time limits can be found here.

Where and how your
accident / incident happened
and details of your injury     

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Contact us about your accident or injury
Call us for free on 0800 0 224 224 Call us from your mobile on 0330 123 123 0 (charged at local number and free when covered by inclusive minutes) Request a call back Text CLAIM to 82010 (standard network rates apply)