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Did you or your loved ones get hurt in a work accident?

Includes repetitive strain injuries, slips, trips, and falls, musculoskeletal injuries, cuts and lacerations, impact injuries, exposure to harmful substances, burns, hearing loss, and eye injuries

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Yes

No

When did the accident happen?

(A guess is good enough)

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Within in the last 30 days

About 1 to 3 months ago

3 to 6 months ago

6 to 12 months ago

About 1-2 years ago

More than 2 years ago

Were you injured while working for the Federal Government?

Includes US Postal Service, Governmental positions, and Military

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Yes

No

Did you get any medical help?

Can include treatment at a hospital, medical practice or with physical therapists, chiropractors, or occupational therapists etc

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Yes

No

Did you notify your employer?

(Don't worry if you haven't)

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Yes

No

What type of injury did you sustain?

(Pick the injury that affected you the most)

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Do you have a lawyer for this case right now?

*

Yes

No

Have you already settled your case?

*

Yes

No

Confirm your details below...

First Name *

Last Name *

Phone *

Email *

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