Medical Experts

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Pre-instruction Request for Experts Form

Please complete the following Pre-instruction/Medical Expert request form and we will provide you with a list of nominated experts within 1 working day.

Solicitor Details

Title * Please Select Mr Mrs Ms Miss Dr

Firstname *

Surname *

Address *

 

Town *

County *

Postcode *

Tel *

Fax

Email *

Client Details

Title * Please Select Mr Mrs Ms Miss Dr

Firstname *

Surname *

Address *

 

Town *

County

Postcode *

Tel *

Email *

Incident & Injury Details

Date of Accident * Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2002 2003 2004 2005 2006 2007 2008 2009 2010

Type of Accident *

Specialist Required *

Special Requirements *

Third Party Details

Insurer *

Address *

 

Town *

County

Postcode *

Tel *

Email *

Medical Records Application

Are the client's medical records required for this case * Yes No

Instructing Party to source records * Yes No

IMR to source records * Expert Solicitor Both

If records to be sourced, copies to be passed to * Expert Solicitor Both

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