Name * Phone number * Email Date of loss (date when accident happened) Type of accident * Car AccidentMotorcycle AccidentPedestrian AccidentTransit AccidentBicycle AccidentOther Were you a ... * DriverPassengerPedestrianBicyclistOther Were you at fault or not at fault? * At faultNot at fault Were you charged with an offence? * YesNo Do you have a police or collision report? * YesNo Do you have personal insurance? * YesNo What is severity of your injuries? Have you been to a hospital or family doctor after the accident? * YesNo Are you currently on ODSP (Ontario Disability Support Program)? * YesNo Were you employed at the time of the accident? * YesNo Have you or are you taking time off work since your accident? * YesNo Have you had any accidents in the past? * YesNo Additional details (optional) *Your contact information will only be used for the purpose of referring you to a lawyer. Click to view our full privacy policy